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 submitting tax returns, bank statements, and pay stubs, 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. 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 online, here on this page, for downloading and printing. Copies of the policy and application are also available at Admissions and the Patient Accounts Department, as well as the Emergency Department.

Financial Assistance Program Policy

Financial Assistance ProgramPlain Language Summary

Financial Assistance Program Application