Financial Assistance

Hospitals in New Hampshire work hard to make quality healthcare available, affordable, and accessible to all, regardless of ability to pay. Monadnock Community Hospital offers financial assistance to ensure that cost of healthcare will not be a barrier to anyone in our community pursuing services they need. If payment of your health care expenses could create a financial hardship for you, our Financial Grant Coordinator will help you apply.

The information you provide is confidential and is only reviewed by the 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.

During 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 and New Hampshire Healthy Kids. 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
  • Copy of your monthly medications

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.

  1. Contact the Financial Grant Coordinator at 924-1717.
  2. An Application will be mailed to you.
  3. Complete the application and send in the following documentation:
    • 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 three 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 food stamp allocation
    • Copies of government assistance notices, such as Social Security Disability and Medicaid
    • Please submit the documentation through the postal services:
    Financial Grant Program
    452 Old Street Road
    Peterborough, New Hampshire 03458
    or
    You can drop it off at the hospital switchboard. Envelopes are available in which to put the documents.

  4. If you need assistance or have questions, please contact the Financial Grant Coordinator to set up an appointment. Notification: Provide information on how patients will be notified that their application has been approved or denied and when. If denied, offer guidelines for next steps or an appeal process if you have one. Please note that financial assistance approval is valid for six months and a new application will have to be submitted after that time.

Making Payments

We know that healthcare 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. Contact:

Patient Financial Services, Financial Counselor at 924-4699 ext. 4281.

Medication

We also understand that you may not be able to pay for medications. MCH has a Medication Bridge Program that can assist you with the application process to apply for assistance with chronic medications. Almost every pharmaceutical company has a patient assistance program with their own set of guidelines. We will work with your provider to determine which medications are delivered to your provider’s office. To see if you may be eligible, please contact the Medication Bridge Coordinator at 924-1794.

Please note that we will not be able to determine eligibility without all the necessary documentation.