Even if you believe that you do not qualify for financial assistance, call us if you will have difficulty paying your bill. There are many factors taken into consideration when determining eligibility. We also may be able to connect you with other resources for which you may qualify, or help you set up a manageable payment plan.

As part of the financial counseling application process, we will assess your potential eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid. If it is determined that you may be eligible for one of these programs, the hospital will assist you in the application process. You will be required to supply the financial or medical documentation that is necessary to secure such insurance coverage.

Criteria Categories for Financial Assistance

• Family income in relation to federal poverty guidelines
• Assets (e.g. home, bank account, and stocks)
• Any additional financial hardship
• You must be receiving medically necessary care

Exclusions for Eligibility
Cosmetic procedures and infertility services are not eligible for financial assistance. All other elective or non-emergent services are covered at the discretion of the health provider or hospital.

Financial Assistance Programs Available at APD Hospital and Clinics

APD Hospital and clinics participate in several statewide programs:

Hospital Access Plus
APD discounts hospital facility and clinic charges for medically necessary hospital services by at least 15% for patients without health coverage or financial assistance. Please call our Credit Coordinator at 603-448-7419 for details.

New Hampshire Medication Bridge
Medication Bridge helps patients without prescription drug coverage with the often-confusing paperwork required to get free prescription drugs from pharmaceutical companies. For more information, please call your primary care provider's office.

New Hampshire Health Access Network
The Network helps low-income people in New Hampshire who do not have enough health insurance or enough money to pay for hospital care, doctor visits or other medical care. Hospitals throughout the state use a uniform set of eligibility guidelines and a common application that makes the process of applying for assistance simpler and more efficient. Please call our Credit Coordinator at 603-448-7419 for details.

How to Apply for Financial Assistance

Call our Credit Coordinator at 603-448-7419. He will advise you and investigate other sources that might provide financial assistance.

You'll also need to complete a financial assistance application, which can be found at the links below:

Download and read the cover letter:
MS Word file or PDF file (PDF files can be opened with Adobe Acrobat Reader. Adobe Acrobat Reader is a free download available here.)

Download and fill out the full application form:
MS Excel file or PDF file

You may also pick up an application at our Admissions desk in the main Hospital building or the registration desk at any hospital owned clinic (Kroner Clinic, Occupational Health Services, the Robert A. Mesropian Center for Community Care, Surgical Clinic or the Women's Care Center), or call us at 603-443-7419 to request that one be mailed to you.

Submit the application with the following documents:

• Complete copy of your most recent Federal Income Tax Return and all schedules, as well as copies of last year's W-2 forms
• Copies of the three most recent paycheck stubs or a statement from your employer
• Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)
• Copies of unemployment, disability compensation benefits statements
• Copies of social security or pension benefits income
• Copy of food stamp allocation
• Copies of government assistance notices such as Social Security Disability and Medicaid

Please submit the above documents through postal service mail or in person; do not email copies as we cannot guarantee the security of your personal information.

Notification

Within 30 days of receiving your application we will send you a letter or call to let you know that your claim has been approved or denied If you have been denied, our Credit Coordinator can counsel you about next steps and the appeal process, if you choose to appeal your denial.

Please note that financial assistance approval is usually valid for six months; a new application will have to be submitted after that time.

Making Payments

We know that health care costs can come up unexpectedly. Whether you are insured or uninsured, whether or not you qualify for financial assistance; we understand that you may have difficulty paying your healthcare costs in full at the time of service or in a lump sum. We are happy to work with any patient to set up a payment plan; please call our Credit Coordinator at (603) 448-7419 to make arrangements.