Plain Language Summary
UNDERSTANDING YOUR OPTIONS FOR AFFORDABLE CARE
Overview
Our mission is to provide healthcare services of exceptional quality to all who need us. This commitment to our community includes providing financial assistance to qualified patients who are unable to pay for all or part of their medical care. Our patients seeking financial assistance must apply for our Charity Care program, which is summarized below.
Hospital Bill Complaint Program
The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the State of California’s Hospital Bill Complaint Program. For more information or to file a complaint, go to HospitalBillComplaintProgram.hcai.ca.gov.
Eligible Services
Financial assistance through the FMC Charity Care program is available for emergency and medically necessary services provided by Fairchild Medical Center. The FMC Charity Care program is generally not available for elective procedures; however, in certain cases, an exception may be made and requires approval by administration.
Eligibility Requirements
Financial assistance through the FMC Charity Care program is determined using the Federal Poverty Income Guidelines Sliding Scale.
The following patients may qualify for full or partial Charity Care:
- Self-pay patients: A patient who is uninsured and who is at or below 400 percent of the Federal Poverty Line (FPL). A patient without third-party overage from a health insurer, healthcare service plan, Medicare, Medi-Cal and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance or other insurance
- Insured patients with limited coverage
- Insured patients who have exhausted their benefits
- Insured patients with high medical costs
- Insured patients with high-deductible plans
How to Apply
The complete FMC Charity Care Policy and the Financial Assistance application form may be obtained at no charge from the Financial Counselor located by Patient Registration; by calling (530) 841-8537 and requesting a mailed, faxed or emailed copy or by download from our form below.
Once a determination has been made, a notification form will be sent to the applicant advising them of the facilities’ decision. Once the patient’s account is reduced by the financial assistance adjustment based on policy, the patient is responsible for the remainder of his/her remaining balance which shall be no more than amounts generally billed.
Completed applications should be submitted in person or by mail to Fairchild Medical Center, 444 Bruce Street, Yreka, California 96097.
If you require further assistance in reviewing our FMC Charity Care policy or completing the Financial Assistance application form, please contact our Financial Services/Billing department by calling (530) 841-8537.