Speare Memorial Hospital does not discriminate and must provide healthcare services to all people in our community. It is the law. During emergencies, we provide care for people in our emergency room, even if they cannot pay.
For more information about Speare Memorial Hospital’s Financial Assistance please visit the links below:
You can also contact our Financial Counselor at (603) 238-6471 or pick up a copy at Speare Memorial Hospital, 16 Hospital Drive, Plymouth, NH 03264,
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.
Financial Assistance Programs
Requesting Financial Assistance
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. The 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 any way 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.
Eligibility 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.
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 financial counseling services at 1-866-557-2555. A financial counselor will advise you and investigate other sources that might provide financial assistance.
FINANCIAL ASSISTANCE APPLICATION
Complete a financial assistance application, which you can click here to print, or pick it up at the financial counselor’s office at Speare Memorial Hospital, or call us at 1-866-557-2555 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. Include copies of last year’s W-2 forms.
- Copies of the four most recent, paycheck stubs or a statement from the 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 current property tax bill showing the assessed value of the property, and a copy of a mortgage statement showing the current mortgage or home equity balance.
- 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.
Qualified patients will receive a letter of approval within 30 days of application and a NH Health Access Network card that can be used at all participating health providers in New Hampshire. Please note that financial assistance approval is valid for six months, or 12 months for those who are Medicare eligible. A new application will have to be submitted after that time.
Patients who do not qualify for NH Health Access Network will also be notified in writing within 30 days of submitting an application but may be eligible for Speare Memorial Hospital Financial Assistance. This program is a financial aid assistance program valid only at Speare Memorial Hospital.
Financial Counselor, (603) 238-6471