St. Joseph Healthcare Financial Assistance Programs
Contact Person: Nancy Harnish
Telephone Number: 207-907-3228
Email: nancy.harnish@sjhhealth.com
Location: Cashier’s Office, St. Joseph Hospital, just to the left of the main entrance doors of the hospital
Free Care Program
Who Qualifies: If your family’s income is 200% or less of the Federal Poverty Guidelines
Income Based Sliding Scale Program
Who Qualifies: If your family earns between 200% and 400% of the Federal Poverty Guidelines.
People who qualify for the sliding scale will receive a 72% discount on the regular charges.
How to Apply: Application for Free Care and Sliding Scale Programs
https://stjosephbangor.org/wp-content/uploads/2021/12/Covenant-FreeCare-Jan-2021.pdf
You need to have an upcoming appointment or have received a bill before you can submit the financial assistance application to the financial assistance counselor at the hospital
Return the application with proof of income and assets for 3 months prior to the date of service to the financial assistance office which is located just to the left of the main entrance to the hospital.
Proof of income includes but is not limited to:
- 3 months' pay stubs.
- if self-employed, the past year's income tax return will be requested, including the Schedule C – Profit and Loss page.
- If paid in cash submit a letter from the employer verifying income for the past 3 months. (see #4 below for more details)
- Other forms of income including, but not limited to: Any income received through the
Social Security Administration, TANF, General Assistance, retirement, pension, child support, wages, unemployment, and workers compensation.
- If you have no income, please clearly state on the application how you are being supported.
Other Things to Know:
- You can only submit an application once you have an appointment or have received a bill for care received.
- If a person has received a bill from St. Joseph’s Healthcare they must apply for financial assistance within 6 months of the date of service in order to apply the free care or sliding scale programs to that bill. If this deadline is missed, they will be held responsible for the entire bill.
- You do not need to provide any proof of residency.
- It is no longer necessary for the person to apply for Mainecare and get rejected before applying for free care or the sliding scale programs.
- If the person has applied for Mainecare and has received notification that they or any of their family members qualify for “Emergency Mainecare” list that and the ID number in the last column on the application.
- If the children in the family have Mainecare, list that and the ID numbers in the last column on the application.
- If the person’s wages are paid in cash, in the line below “If you have no income….” Write Paid in Cash. If the employer refuses to write a letter verifying income for the past 3 months, complete a Self Employment Profit and Loss Statement and a Self Affidavit of Income Letter and attach it to the application. A handwritten letter stating that they are self-employed but do not file taxes, along with a ledger showing the hours they have worked each day, and what they were paid over the last 13 weeks would also suffice if someone didn't want to fill out this form.
- Under household members, list all family (spouse and children but not parents) that the person is supporting even if they are living in their home country. If no Social Security Number, write N/A in the column for Social Security Number.
- If the person is married and the spouse lives in the same household and if they file taxes, file jointly, then one application would apply to both the husband and wife as well as any children under the age of 18. In this case both incomes would need to be reported on the application.
- Each application is valid for only 6 months. A new application needs to be submitted if the person has appointments or received a bill 6 months after the date of the initial application.
- We suggest that your family completes the Authorization for Permission to Verbally Discuss Health Information form (unless your mentee speaks English). Otherwise, no one on the support team will be able to talk to St. Joseph’s Hospital about financial assistance, billing, appointments, care, etc.
What is Covered: Outpatient services, radiology, laboratory, and pathology services as well as inpatient hospital services except for charges billed by the hospitalists.
All services provided by the hospitalists (doctors and mid-level providers providing inpatient care) will be billed at the full rate.
Useful Links:
Financial Assistance
https://stjosephbangor.org/patients-visitors/billing-insurance/financial-assistance/
Financial Assistance Policy
https://stjosephbangor.org/wp-content/uploads/2023/10/Convenant-Financial-Assistance-Policy.pdf
Application for Free Care and Sliding Scale Programs
https://stjosephbangor.org/wp-content/uploads/2021/12/Covenant-FreeCare-Jan-2021.pdf
Poverty Guidelines – 2023
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines