Beaufort Regional Health System


Untitled Document Home Beaufort Regional Health System About the Health System Services Board of Commissioners Beaufort County Medical Center About Us Patient Information Visitor Information Cardiopulmonary Gastroenterology/Coastal Gi Hospitalist Program Radiology White Rheumatology Find A Physician By Name By Specialty By Practice Careers Job Openings Employment Application For Referral Sources Volunteer Services Our Subsidiaries Aurora Medical Center Beaufort Regional Home Health Behavioral Health Birdsong Orthopedics Chocowinity Family Care George Miller Orthopedics InnerBanks Urgent Care Lifestyles Medical Fitness Center Marion L. Shepard Cancer Center OBGYN of Washington Pamlico Internal Medicine Pamlico Medical Equipment Pamlico Psychiatry Services Ray G. Silverthorne Crisis Center Seaboard Surgical Associates Tideland Psychiatric Services Washington Family Medicine Washington Urological Associates Zack Waters, MD Physician Opportunities Support Groups & Education News at BRHS Community Calendar Directory Contact Us Privacy Practices Practicas de Privacidad BRHS Request For Proposal Meeting Notices Patient & Visitors Map	BRHS Charity Assistance Financial Policy Purpose: As conditions of participation in the Medicaid Disproportionate Share Program, Beaufort Regional Health System will provide care to persons who are unable to pay for their care. Procedure: The Patient Financial Services staff will perform a financial screening of all Self Pay or under insured patients. In order to be eligible for financial assistance, you must: • Have no other source of payment i.e., insurance coverage, governmental assistance with your Hospital bills or savings accounts. • Have hospital bills beyond your financial resources. • Provide proof of verifiable income and all income resources. • Complete a full application and provide all information as required by the Hospital. • All avenues for any 3rd party reimbursement must have been exhausted prior to the write off. This writes off will apply only to the remaining balance on the account. The following documents must be attached to process application for Financial Assistance. • Proof of Income: Prior year income or wage verification. • Social Security statement, if applicable. • Last month’s bank statement. • Other documents as requested by BRH. • Signed authorization for Release of Information. The information provided in this application will be verified by the Hospital and will be used as a tool to determine the ability of the patients to pay The Hospital debts. The Hospital will verify assets through the public records search resources and obtain credit scores when applicable. The application and all documentation are forwarded to Director of Patient Financial Services for final approval. Accounts with balances greater than $10,000.00 must have the VP of Finance sign off for final approval. Patients at or below 200% of Federal Poverty Guidelines and whose application is approved are eligible for 100% write off of the charges for non-elective care. For more information please call Patient Financial Services Department at 975-4228. BRHS Charity Financial Assistance Form BRHS Charity Care Application BRHS Charity Eligibility Guidelines

Home \| Site Map \| Notice of Privacy Practices Beaufort Regional Health System 628 East 12th Street, Washington, NC 27889

Untitled Document

BRHS Charity Assistance Financial Policy

Purpose: As conditions of participation in the Medicaid Disproportionate Share Program, Beaufort Regional Health System will provide care to persons who are unable to pay for their care.

Procedure: The Patient Financial Services staff will perform a financial screening of all Self Pay or under insured patients. In order to be eligible for financial assistance, you must:
• Have no other source of payment i.e., insurance coverage, governmental assistance with your Hospital bills or savings accounts.
• Have hospital bills beyond your financial resources.
• Provide proof of verifiable income and all income resources.
• Complete a full application and provide all information as required by the Hospital.
• All avenues for any 3rd party reimbursement must have been exhausted prior to the write off. This writes off will apply only to the remaining balance on the account.

The following documents must be attached to process application for Financial Assistance.
• Proof of Income: Prior year income or wage verification.
• Social Security statement, if applicable.
• Last month’s bank statement.
• Other documents as requested by BRH.
• Signed authorization for Release of Information.

The information provided in this application will be verified by the Hospital and will be used as a tool to determine the ability of the patients to pay The Hospital debts. The Hospital will verify assets through the public records search resources and obtain credit scores when applicable. The application and all documentation are forwarded to Director of Patient Financial Services for final approval. Accounts with balances greater than $10,000.00 must have the VP of Finance sign off for final approval. Patients at or below 200% of Federal Poverty Guidelines and whose application is approved are eligible for 100% write off of the charges for non-elective care.

For more information please call Patient Financial Services Department at 975-4228.

BRHS Charity Financial Assistance Form

BRHS Charity Care Application

BRHS Charity Eligibility Guidelines

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Beaufort Regional Health System
628 East 12th Street, Washington, NC 27889