Financial Assistance—Weeks Health Access

Weeks Health Access—Financial Assistance

Weeks Medical Center Billing and Collections Policy

Financial Assistance Policy

Financial Assistance Policy Plain Language Summary

EMTALA Reporting Policy

Weeks Health Access is a local financial assistance program to help you with the care you need when you need it most. Patients who meet criteria for participation can receive help with their medical bills for services received at Weeks Medical Center facilities. In addition, if patients further qualify, they may also enroll in our Pharmaceutical Assistance Program, which can provide needed medications at greatly reduced prices. For complete guideline information: Weeks Health Access/NH Health Access Program.

Who qualifies?

Any patients who lives within our catchment area, which includes all of New Hampshire and Vermont and Oxford County, Maine. 

How to apply.

Follow these steps:

  • Complete financial forms:  Financial Assistance application  (PDF)
  • Submit forms, including NHHA Checklist (PDF) with copies of income (paycheck stubs, Social Security benefit statement)
  • Submit copy of a recent tax return
  • Submit a copy of liquid assets (checking and or savings account statement, Certificates of Deposits, etc.).
  • Sign IRS Form 4506T  (PDF)

Is there a cost to me?

There may be a co-pay for medical care or handling charge for the Pharmaceutical Assistance Program. The amount is based on your income and assets. You are expected to present the co-pay at the time you receive service.

What help can I get?

  • Bills incurred at Weeks Medical Center for non-elective services with the hospital or doctor’s office (lab, x-ray, room charges)
  • Doctor bills for providers employed by Weeks Medical Center
  • Weeks applies on your behalf to the drug companies for help with medications. Each company has its own criteria; therefore, approval for participation in the WHA program does not guarantee approval by the pharmaceutical companies.

Provider Appendix

Participating and Non-Participating Providers in the Weeks Medical Center Financial Assistance Program

Participating Providers

  • Weeks Medical Center Employed Providers
    • Includes emergency, hospitalists, surgeons, podiatrists, wound care, and all clinic providers
  • Dartmouth-Hitchcock radiologists
  • Dartmouth-Hitchcock oncologists
  • Urology Services – Dr. Jennifer Lucas & Dr. Jerry Rittenhouse

Non Participating Providers

Please note, these providers/hospitals may offer financial assistance through their own programs. Please contact them directly if you do receive a bill for services incurred at Weeks Medical Center.

  • New England Heart and Vascular Institute (Catholic Medical Center)
  • Dartmouth-Hitchcock Medical Center Pathology
  • Androscoggin Valley Hospital Specialists
    • Pulmonary
    • ENT
    • Neurology
    • Sleep Medicine

 

For further information, please call the Weeks Medical Center Business Office at 603-788-5354.

Related Topics