Financial Assistance Policy
Health Services in Central Utah Valley
A HELPING HAND
Central Valley Medical Center’s mission is to provide sensitive and
compassionate health care. As part of this mission, Central Valley Medical
Center offers financial assistance through its Financial Assistance Program
to patients unable to pay for emergency or medically necessary care.
ELIGIBILITY REQUIREMENTS AND ASSISTANCE OFFERED
Eligibility for financial assistance is based on multiple factors, including
condition and care required, insurance coverage or other sources of payment
(including personal injury claims), income (Federal Poverty Level guidelines
used to determine the amount of financial assistance offered), family size.
Patients must comply with the application process, including income verification
(submitting pay stubs, tax returns, and bank statements) as well as completing
the application process for all available sources of assistance, including
Medicaid or other Medical Assistance. Patients will be given 120 days
to complete the application process. If not completed within 120 days,
collection activities may be continued.
HOW TO APPLY FOR ASSISTANCE
The patient or any person involved in the care of the patient, including
a family member or provider, can express financial concerns during the
patient’s care. The patient or responsible party will then be encouraged
to complete a Financial Assistance Application.
Financial assistance is limited to medical care provided at Central Valley
Medical Center and related clinics. Central Valley Medical Center will
uphold the confidentiality and dignity of each patient, and any information
submitted for consideration of financial assistance will be treated as
protected health information under the Health Insurance Portability and
Accountability Act (HIPAA).
WHERE TO OBTAIN COPIES
Our Financial Assistance Program and Application are available free of
charge by contacting our Patient Billing Department at 435-623-3000 and
requesting a copy by mail. The policy and application are also available
below for downloading and printing. Copies of the policy and application
are also available at Admissions, Patient Billing Department, and the
Emergency Department.
Financial Assistance Program Policy
Financial Assistance Program Plain Language Summary
Financial Assistance Application