Charity Care and Financial Assistance Program

Jefferson Healthcare is committed to providing health care services to all people who are in need of medical attention, regardless of their ability to pay. To demonstrate this commitment, Jefferson Healthcare signed the American Hospital Association’s Confirmation of Commitment, which states that the hospital’s and clinics’ policies and practices on charges, charity care, billing, and debt collection meet or exceed the principles and guidelines of the board of trustees of the American Hospital Association.

    • The credit policy of the hospital and clinics provides four options for self-pay or uninsured patients, depending on their level of financial need.
    • If a patient has the means to pay his or her bill, a 20 percent discount is offered for self-payment in full within 30 days of the postmark on the itemized bill.
    • Patients who have the means but who need to spread out their payments may make monthly payments on their accounts, paying the balance in full within three months. When a more extended payment plan is needed, other arrangements may be made upon request.
    • When patients do not have the means to pay their bill, a financial services representative will assist them in determining whether they are eligible for Medicaid.
    • For patients not eligible for Medicaid and whose income is below 400 percent of the current federal poverty standard, the charity care and sliding fee scale programs are available.

Charity Care

The charity care policy is applied uniformly to all Jefferson County residents who use Jefferson Healthcare for their health care needs. We treat all patients equitably and with dignity and respect. We make every effort to ask patients whether they need financial assistance to pay for part or all of the care they have received or will receive.

    • The following patients qualify for charity care:
      Patients whose gross family income is at or below 200 percent of the current federal poverty level are eligible to receive charity care and to have their full charges written off.
    • Patients whose gross family income falls between 201 percent and 400 percent of the current federal poverty level are eligible for a reduction in their charges, based on a sliding fee schedule.
    • Patients whose life circumstance indicates severe medical hardship may be eligible for charity care even if the family income exceeds 400 percent of the current poverty level. This is determined on a case-by-case basis.

Note: The federal poverty level varies with the number of family members and is periodically updated. Apply for Charity Care Upon request, the patient or responsible party will be given charity care forms and instructions. The patient will be asked to provide documentation of income. Patients may apply for charity care at any point, from pre-admission to final payment of the bill. The information from the application is used solely for the purpose of qualifying the patient for Medicaid, charity care, or the sliding scale. If a patient is eligible for certain other programs, such as Medicaid, they may not qualify for charity care. Patients seeking charity care are not required to seek loans to pay for medical bills.

If you have more questions, please call us at (360) 385-2200 ext. 2267

Charity Care Policy and Fee Scale

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Charity Care Application

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Financial Services

360.385.2200 ext. 2267

Financial Assistance

Washington State requires all hospitals to provide financial assistance to patients and families who meet certain income requirements. Assistance is based on family size and income, even if you have health insurance. Financial Assistance options may include:

  • Patient Access Link (PAL): Jefferson Healthcare’s Financial Assistance, which includes an opportunity to apply for charity care or the sliding fee scale as regulated by Washington law
  • Prompt Pay Discount: A paid-in-full discount applies to balances paid within thirty (30) days of a statement being mailed. The amount of discount offered is based on the invoice balance, but not applied to copayments
  • Payment Plan Arrangements: After consultation with a financial counselor, patients may request or be offered an option to split their payments over three (3) months from the date of the first statement if they are unable to pay the full balance during the initial billing cycle.
  • Other funding sources: If patients are eligible for other no-cost funding sources (Medicaid/DSHS), they must apply for those services and receive a determination prior to being considered for charity care or the sliding fee scale programs.

What does financial assistance cover?  The hospital financial assistance covers appropriate hospital-based services provided by Jefferson Healthcare, depending upon eligibility. Financial assistance may not cover all health care costs, such as copayments or services provided by other organizations.

If you have questions about financial options or need help completing this application:It is the goal of the Financial Services Office to connect patients with the most appropriate financial services option(s) available. The Financial Services Office is located on the main floor of the hospital at 834 Sheridan in Port Townsend. You can also reach the office by phone at (360) 385-2200 ext.2267, 9am-4:30pm. Office hours are 9:00am-5pm, Monday-Friday. You may obtain help for any reason, including disability and language assistance.

In order for your application to be processed, you must:

  • Provide us information about your family

Fill in the number of family members in your household (family includes people related by birth, marriage, or adoption who live together)

  • Provide us information about your family’s gross monthly income (income before taxes and deductions).
  • Provide documentation for family income and declare assets.
  • Attach additional information if needed.
  • Sign and date the form

NoteYou do not have to provide a Social Security Number to apply for financial assistance. If you provide us with your Social Security Number it will help speed up the processing of your application.  Social Security Numbers are used to verify information provided to us. If you do not have a Social Security Number, please mark “not applicable” or “NA.”

Mail or fax completed application with all documentation to: Jefferson Healthcare – 834 Sheridan Street, Port Townsend, WA 98368. The application may also be faxed to (360) 379-4381. Be sure to keep a copy for yourself.

 To submit your completed application in person: The Financial Services Office is located on the main floor of the hospital at 834 Sheridan in Port Townsend. Upon arriving at the main entrance (off of Sheridan and 7th), a concierge at the Registration Desk will be happy to direct you to the office.

We will notify you of the final determination of eligibility and appeal rights, if applicable, within 14 calendar days of receiving a completed financial assistance application, including documentation of income.

By submitting a financial assistance application, you give your consent for us to make necessary inquiries to confirm financial obligations and information.