Financial Assistance “We’re Here To Help!”

North Country Hospital understands health care costs can present a financial hardship to families and individuals. It is our intent to help those who meet certain income and asset guidelines. You may request an application from the Registration Office (off the main lobby), the Emergency Room Registration desk or the Patient Accounting office (off the main lobby), or call the telephone number listed below to have one mailed to you.

Instructions for applying for Financial Assistance at North Country Hospital

In order to promptly process your application for financial assistance,
the following is requested with your application:

1. Medicaid “Notice of Decision”– applicants are asked to apply for medical health care benefits through the Vermont. Dept. of Prevention, Assistance, Transition, and Health Access, 100 Main St. Suite 240, Newport, Vermont. Telephone 802-334-6504

2. Proof of Income - proof may be one or more of the following:

A. A current year income tax return including all forms and schedules.
B. A Social Security statement or check, or a bank statement showing direct deposits of your monthly income (social security/disability).
C. Medicaid (General Assistance).
D. (4) recent paychecks/unemployment checks.

We ask that the application be filled out completely and signed.

If you have any questions about the application process, or need assistance in completing the
application, you are encouraged to call our Patient Accounts office at (802)334-3274/3273. Our office hours are 8:00 to 4:30, Monday through Friday.

(If your Income is less than 200 % of the U.S. Federal Poverty guideline for your family size,
the patient pays $0.00.)