Donate Now
Secure donations through
Network for Good

Financial Assistance

We’re Here to Help

Thank you for choosing Alice Peck Day Memorial Hospital. Our mission is to serve you and the community with the best possible health care. Hospital charges and insurance statements can be hard to understand. We want to help you be ready for your visit in all ways, including the financial aspects.

If you’re not sure how you’re going to pay your bill, we will provide you with information and contacts for a number of programs that may help you. Our staff will help you with the application process when we can. To get an application, visit the Patient Access Department at APD, call (603) 448-3121 to ask for the forms to be mailed to you, or download the Financial Aid Cover Letter & Financial Assistance Application Form.

 

APD Financial Assistance Programs

The program helps insured and uninsured patients whose household incomes are at or below 200% of the Federal Poverty Guidelines with 100% APD financial assistance.  There is a sliding scale for those who qualify for up to 300% of Federal Poverty Guidelines. To qualify, your income should be at or below the amounts shown on this 2014 chart:

Household size/Annual Household Gross (pre-tax) Income
Persons in
Household
200%FPL
100% Assistance
300% FPL
Sliding Fee
1 $23,340 $35,010
2 $31,460 $47,190
3 $39,580 $59,370
4 $47,700 $71,550
5 $55,820 $83,730
6 $63,940 $95,910
7 $72,060 $108,090
8 $80,180 $120,270

For each additional family member add $4,060.

To get an application, visit the Patient Access Department at APD, or call (603) 448-3121. APD financial assistance guidelines are updated each year to reflect changes in the Federal Poverty Guidelines.

 

APD Discount and Payment Plan Programs

Our payment plan helps patients who realize they cannot pay before their treatment or within 30 days of receiving their first statement. The payment calendar will be based on the amount of money that is due. We may ask for a “good faith” payment on arrangements that will last more than six months. If you are unable to make full payment, please call the telephone number on your patient statement.

  • APD offers uninsured patients an automatic 15% discount, which will be reflected on your first patient statement.
  • A 10% prompt-pay discount will be applied if you pay your patient balance in full within 10 days of receiving your patient statement.
  • You must apply and APD must verify your application before you qualify for any of these programs or discounts.
  • To get an application, visit the Patient Access or call (603) 448-3121. 

Price Estimates for Services at APD

You may ask for a price estimate at any time for all services provided at APD. For certain services, you will get a letter in the mail from the Patient Access Department after your care has been scheduled that includes the estimated price of your upcoming service.

  • The estimate can help you in planning payment arrangements.
  • You may be billed separately for professional services provided by physicians, nurse practitioners, midwives or anesthesia professionals not employed by APD. These charges will not be included in estimates provided by the hospital, so you should also ask these providers for their estimates if you need them. The Patient Access team can help you if you aren’t sure which providers you need to ask for an estimate.

Contacts for Obtaining Medical Insurance/Prescription Assistance

Medicaid of NH

A federal and state-funded program that serves needy individuals and families who meet financial and other eligibility requirements, or individuals who lack adequate resources to pay for medical care.

To learn more go to www.dhhs.state.nh.us, call toll-free 1-800-852-3345 extension 4238, or contact APD’s Patient Access Department at (603) 448-3121.

NH Healthy Kids

Provides access to low-cost and free health coverage  for New Hampshire’s uninsured children and teens.

To learn more go to www.nhhealthykids.com, call 1-877-464-2477 or contact APD’s Patient Access Department at (603) 448-3121.

Vermont Health Insurance Programs

These programs include Catamount Health, Vermont Health Access Plan (VHAP), Dr. Dynasaur, Medicaid, and a number of pharmacy assistance and insurance premium assistance programs.

To learn more go to www.greenmountaincare.org, call 1-800-250-8427, or contact APD’s Patient Access Department at (603) 448-3121.

Medicare

Medicare is a health insurance program for people age 65 or older, some disabled people under age 65, and people of all ages with end-stage renal disease.

To learn more go to www.medicare.gov/MedicareEligibility, visit or call your local Social Security office, or contact APD’s Patient Access Department at (603) 448-3121.

This document will be updated regularly. Last revision 3/15/2011.