• Union County General Hospital
  • 300 Wilson Street
  • Clayton, New Mexico 88415
  • Phone: 575-374-7012
  • info@ucgh.net

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Patient Forms and Policies

Plain Language Summary of Financial Assistance Policy

As part of its contribution of resources, advocacy and community support to promote the health status of the community, which it serves, the hospital will provide financial assistance to patients with a demonstrated inability to pay for medically necessary services in accordance with the hospital’s Financial Assistance Policy.

All patients may apply for financial assistance, including those with insurance. The patient’s situation will be evaluated according to relevant circumstances, such as income, assets or other resources available to the patient or the patient’s family and the amount of the outstanding balance. It is ultimately the patient’s responsibility to provide the necessary information to qualify for financial assistance. There is no assurance that the patient will qualify for financial assistance.

Established eligibility criteria and discount guidelines will be used to determine what amount, if any, of an outstanding patient account balance qualifies for financial assistance. Patients whose yearly household income is at or below 200% of the Federal Poverty Guidelines (FPG) will receive a 100% discount. Patients whose yearly household income is above 200% but not more than 400% of FPG are eligible to receive services at a discounted amount. Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount.

No patient who qualifies for financial assistance will be charged more for emergency or other medically necessary care than amounts generally billed to patients having insurance.

Free copies of this Plain Language Summary, the Financial Assistance Policy, and the financial assistance application are available on the hospital’s website at www.ucgh.net, are available in the hospital’s admissions area and emergency department, can be obtained by calling 575-374-2585, and can be requested by mail: CLAYTON HEALTH SYSTEMS, Inc – 300 Wilson St – Clayton, NM 88415.

http://www.ucgh.net/files/Bad%20Debt%20Policy%205.4.pdf

http://www.ucgh.net/files/Discount%20and%20Payment%20Plan%20Policy%2004.23.pdf

http://www.ucgh.net/files/Financial%20Assistance%20Policy%204.23.pdf

http://www.ucgh.net/files/FINANCIAL%20ASSISTANCE%20APPLICATION%20FORM.pdf

http://www.ucgh.net/files/Plain%20Language%20Summary%20Financial%20Assistance.pdf