FALLON MEDICAL COMPLEX
Patient Care Financial Assistance
Plain Language Summary
Fallon Medical Complex is committed to providing access to emergency and medically necessary healthcare services to patients who are uninsured or have a need for financial assistance.
What is financial assistance?
Financial Assistance is a program to provide free or discounted emergency or medically necessary care at Fallon Medical Complex (FMC). To be eligible, patients must have family incomes at or below the Federal Poverty Guidelines. Assistance may be available in other limited situations, depending on circumstances.
Our program is designed to provide assistance to responsible parties who do not have the financial ability to pay for their medical services.
If your income is below 250% of the current Guidelines (which are updated annually), you may qualify for a write off of all or a percentage of your account. A financial assistance discount is only available on medically necessary services.
How do I request financial assistance?
Patients may apply for financial assistance by completing a Financial Assistance Application. The full policy and applications are available below, or at the FMC Business Office Admissions Desk, or FMC ER. Patients may also receive free copies by mail, by calling (406) 778-3331.
What do I need to provide along with my request for financial assistance?
Return the application completed in its entirety along with:
- Copies of three most recent pay stubs for each wage earner in household.
- Copy of your most recent complete tax return, including all schedules.
- Three months of all bank account statements
- A statement detailing your need for financial assistance, including a detail of other medical bills owed
What should I expect?
Your application will be reviewed and a decision will be communicated to you within 30 days. All information will remain confidential.
A patient qualifying for financial assistance under FMC’s policy will not be charged more than the amounts generally billed by FMC for the same services to patients who have insurance covering such care.
Where do I send my application?
Completed applications should be submitted via mail or in person to:
By mail:
Fallon Medical Complex
Attn: Business Office Manger
PO Box 820
Baker, MT 59313
In person:
Fallon Medical Complex
202 South 4th Street
Baker, MT 59313
Persons seeking more information or assistance in completion of the application may contact the FMC Business Office Manager at (406) 778-5308.