Financial Assistance - North Memorial Health - Robbinsdale Hospital

North Memorial Health offers financial assistance programs for patients based on family income and medical expenses, who meet the one of the following:

• Patients with a family income at or below 200% of the Federal Poverty Level (FPL) may be eligible for a 100% discount.

• Patients with a family income at or below 300% of the FPL may qualify for an Amounts Generally Billed (AGB) discount.

• Patients with a family income at or below 300% of the FPL whose medical bills exceed 25% of their income may apply for a catastrophic care discount for a single episode of care or ongoing medically necessary services for a specific diagnosis.

NOTE: Eligibility may consider liquid assets, and patients may need to adjust assets to qualify for the full discount. Emergency and medically necessary services require submission to insurance before determining financial assistance. Patients may also be asked to apply for alternative coverage, such as Medical Assistance, before financial assistance is granted. A financial assistance application is required to determine eligibility.

Provided instructions with application

Vary

The financial assistance application process at North Memorial Health is as follows: Step 1: Access the Application by:

• Downloading it online: https://northmemorial.com/financial-assistance/, including the Shelter Statement version

• Request by mail: North Memorial Health - Robbinsdale Hospital: Financial Assistance

3300 Oakdale Avenue North, Robbinsdale, MN 55422

• Request by phone: (763)581-0911 or (833)494-2900

• Pick up at hospital registration or financial assistance locations, including Robbinsdale, Maple Grove, and select ambulance sites.

Step 2: Submit the Application

• Completed applications, with all required documentation, should be submitted in person or mailed to the address above. Applications are reviewed promptly, and applicants are notified of eligibility in writing within 30 days of receiving a complete application.

• Incomplete applications will not be considered, but applicants will be contacted and given 30 days to provide missing information or documentation.

MN