The HMH Hospitals Corporation (“Hospitals”) Financial Assistance Policy and Financial Assistance Policy (Charity Care/Kid Care/Medicaid) (hereinafter, together, “FAP”) exists to provide eligible patients partially or fully-discounted emergency or other medically necessary healthcare services provided by HMH Hospitals Corporation. Patients seeking Financial Assistance must apply for the program, which is summarized herein.
Eligible Services- Emergency or other medically necessary healthcare services provided by Hospitals and billed by Hospitals. The FAP only applies to services billed by Hospitals. Other services which are separately billed by other providers, such as physicians or laboratories, are not eligible under the FAP.
Eligible Patients- Patients receiving eligible services, who submit a complete Financial Assistance Application (including related documentation/information), and who are determined eligible for Financial Assistance by Hospitals.
How to Apply- FAP and related Application Forms may be obtained/completed/submitted as follows:
View & Print information on Hospitals’ Website
Website: An individual can view information about financial assistance online at the following website: https://www.hackensackmeridianhealth.org/
Application: An individual can apply for financial assistance by filling out a paper copy of the application. The paper application is available free of charge by any of the following methods:
a) By Mail: By writing to the following address and requesting a paper copy of the financial assistance application:
HUMC patients 100 First Street – Suite 300 Hackensack, NJ 07601,
Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047,
Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, Bayshore Medical Center, and Raritan Bay Medical Center – 1945 Route 33, Neptune NJ, 07753
b) In Person: By stopping by the Financial Assistance Department in person (Monday thru Friday, 8:00AM-4:00 PM), located at the following address:
- HUMC,100 First Street – Suite 300 Hackensack, NJ 07601
- Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753
- Ocean Medical Center, 425 Jack Martin Boulevard, Brick, NJ 08724
- Riverview Medical Center, 1 Riverview Plaza, Red Bank, NJ 07701
- Southern Ocean Medical Center, 1140 Route 72 W, Manahawkin, NJ 08050
- Bayshore Medical Center, 727 N Beers St, Holmdel, NJ 07733,
- Meridian Family Health Center, 1828 W Lake Ave # 202, Neptune, NJ, 07753
- Jane H Booker Family Health Center, Neptune, NJ, 07753
- Booker Behavioral Health Center, Shrewsbury, NJ, Parkway 100 Behavioral Health Center, Neptune, NJ, 07753
- Raritan Bay Medical Center, 530 New Brunswick Ave, Perth Amboy, NJ
c) By Phone: The Financial Assistance Department can be reached at (551) 996-4343 Hackensack University Medical Center, (201) 854-5092 Palisades Medical Center, or (732) 902-7080 all other locations.
Summary Application Process –
- Patient completes a written application that requests household income, household assets, family size
- Proof of residency is required in the form of NJ driver’s license, utility bill or other support letter.
- Application is reviewed for completeness and accuracy.
- Request is made to the patient for any missing information
- Application approval or denial is sent
Available Languages– The Financial Assistance Policy, application, and plain language summary are available in the primary language of any populations with limited proficiency in English (“LEP”) that constitute the lesser of five (5%) percent or 1,000 individuals within the primary service area served by Hospitals.
Completed applications can be sent to the Financial Assistance Department to the addresses above.
Determination of Financial Assistance Eligibility- Generally, Eligible Persons are eligible for Financial Assistance, using a sliding scale, when their Family Income is at or below 500% of the Federal Government’s Federal Poverty Guidelines (FPG).
Eligibility for Financial Assistance means that Eligible Persons will have their care covered fully or partially, and they will not be billed more than “Amounts Generally Billed” (AGB) to insured persons (AGB, as defined in IRC Section 501(r) by the Internal Revenue Service). Financial Assistance levels, based solely on Family Income and FPG, are determined if income is up to 500% of FPG.
Note- Other criteria beyond FPG are also considered (e.g., availability of cash or other assets that may be converted to cash, and excess monthly net income relative to monthly household expenditures), which may result in exceptions to the preceding. If no Family Income is reported, information will be required as to how daily needs are met. Hospitals’ Financial Assistance Department reviews submitted applications which are complete, and determines Financial Assistance Eligibility in accordance with Hospitals’ Financial Assistance Policy. Incomplete applications are not considered, but applicants are notified and given an opportunity to furnish the missing documentation/information.
Help, assistance, or questions, can be acquired and answered by stopping by the Financial Assistance Department in person (Monday thru Friday, 8:00AM-4:00 PM), located at the following address:
- Hackensack University Medical Center, 100 First Street – Suite 300 Hackensack, NJ 07601
- Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047
- Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ, 07753
- Ocean Medical Center, 425 Jack Martin Boulevard, Brick, NJ 08724
- Riverview Medical Center, 1 Riverview Plaza, Red Bank, NJ 07701
- Southern Ocean Medical Center, 1140 Route 72 W, Manahawkin, NJ 08050
- Bayshore Medical Center, 727 N Beers St, Holmdel, NJ 07733,
- Meridian Family Health Center, 1828 W Lake Ave # 202, Neptune, NJ, 07753
- Jane H Booker Family Health Center, Neptune, NJ, 07753
- Booker Behavioral Health Center, Shrewsbury, NJ, Parkway 100 Behavioral Health Center, Neptune, NJ, 07753
- Raritan Bay Medical Center, 530 New Brunswick Ave, Perth Amboy, NJ