Northwest Surgical Hospital recognizes there are times when patients may have difficulty paying for services received. Financial Assistance may be available to patients who do not qualify for state or federal assistance. In most cases, patients that fall between 0-150% of Federal Poverty Guidelines based on total household income may have a 100% Financial Assistance discount processed (subject to income verification/documentation requirements). In certain cases, other discounts ranging from 62-90% may apply if the patient’s total household income exceeds these thresholds. Further eligibility and assistance information, a copy of our financial assistance policy, the Financial Assistance application form and a plain language summary of the Financial Assistance policy (English or Spanish) are available by contacting the Northwest Surgical Hospital Customer Service Department at 1-405-419-8444.
Who is Eligible for Financial Assistance?
Financial assistance is generally determined by your total household income as compared to the Federal Poverty Level. Patients with family incomes less than or equal to 150% of the Federal Poverty Level are eligible for a 100% charity care write-off of the portion of the charges for which you are responsible. Patients with family incomes ranging from 151% to 300% of the Federal Poverty Level, are eligible for discounted rates on a sliding scale. To qualify for financial assistance, patients must complete a financial assistance application, provide requested documents to verify financial need and meet other eligibility criteria. Patients who are eligible for financial assistance will not be charged more for eligible care than the amounts generally billed to patients who have insurance coverage covering such care. You may be asked if you have insurance of any kind to help pay for care. You may be asked to show that insurance or a government program will not pay for care.
What Services Are Covered?
Financial Assistance is only available to emergency and other medically necessary care. These terms are defined in the Financial Assistance Policy. Elective services are not covered by the Financial Assistance Policy.
How Can I Apply?
You must apply for financial assistance by completing a written application and providing requested supporting documentation, as described in the Financial Assistance Policy and the Financial Assistance Policy application. The Financial Assistance Policy application instructions will be made available upon patient request at the time of service.
If a patient wishes to apply for financial assistance after the medical services have been provided, the Financial Assistance Policy application instructions may be accessed and printed directly from this page.
Patients may also request a copy of the Financial Assistance Policy application instructions by mail. To request a copy of the documents by mail, patients should call the Customer Service department at 405-419-8444.
How Can I Get Help with an Application?
For help with a Financial Assistance Policy application, you may contact:
Northwest Surgical Hospital Customer Service
14024 Quail Springs Parkway
Oklahoma City, OK 73134
After the application has been reviewed, a determination of eligibility or non-eligibility will be made and you will be notified of the decision.
How Can I Get More Information?
Copies of the Financial Assistance Policy and application form are available below and at the Northwest Surgical Hospital Customer Service center, 14024 Quail Springs Parkway, Oklahoma City, OK 73134 within HPI. Free copies of the Financial Assistance Policy and application also can be obtained by mail by calling the Customer Service department at 405-419-8444. Additional information about the Financial Assistance Policy is also available upon request in any admissions area and at Customer Service, 14024 Quail Springs Parkway, Oklahoma City, OK 73134 or by telephone at 405-419-8444.
What If I Am Not Eligible?
If you do not qualify for financial assistance under the Financial Assistance Policy, you may qualify for other types of assistance. For more information, please contact Northwest Surgical Hospital Customer Service, 14024 Quail Springs Parkway, Oklahoma City, OK 73134 or by telephone at 405-419-8444.