Financial Assistance

Hospitals in New Hampshire work hard to make quality health care available, affordable, and accessible to all, regardless of ability to pay. Parkland Medical Center offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community getting the health care services they need. If payment of your health care expenses could create a financial hardship for you, our staff will work with you to apply for financial assistance. Information you provide is confidential and is only reviewed by staff processing your application.

Even if you do not feel you qualify for financial assistance, call us anyway to receive an application. 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.

As part of the financial counseling application process, the hospital 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.

How to Apply for Financial Assistance

Call for financial assistance at (603) 421-2079. A financial counselor will advise you and investigate other sources that might provide financial assistance.

Complete a financial assistance application and checklist/coverletter along with following documents:

  • Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year’s W-2 forms. If you do not have copies of these forms, you may request them by completing the Request for Transcript of Tax Return Form 4506-T
  • Copies of the three most recent, paycheck stubs or a statement from the employer. If you do not have a source of income, please submit the No Income/Support Verification Form.
  • Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.). If you do not have a bank account, please submit the No Bank Account Verification Form.
  • 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

Patients are notified in writing if application has been approved or if more information is needed. Please note that financial assistance approval is valid for 6 months and 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.