Billing and Financial Assistance
Compass Memorial Healthcare (MMH) and Clinics are committed to providing remarkable healthcare that makes a difference to the communities we serve. We are committed to providing health care services and acknowledge that in some cases an individual will not be financially able to pay for services received.
Financial AssistanceFINANCIAL ASSISTANCE POLICY
Financial Assistance Offered
Financial assistance to eligible uninsured individuals, as well as underinsured individuals receiving emergency or other non-elective medically necessary services covered by the financial assistance policy, based on financial need. Compass Memorial Healthcare uses the Department of Health and Human Services Federal Poverty Guidelines (FPG) to determine eligibility for assistance. Individuals with a household income level that does not exceed 300% on the FPG will be considered eligible for assistance.
Amount Generally Billed
All uninsured individuals and individuals that qualify for financial assistance will not be charged more than the amount we generally bill patients with Medicare coverage for emergency or other medically necessary care.
How to Obtain Copies of Our Policy and Application
You may obtain a copy of our Policy and the Financial Assistance application form: (1) on the Compass Memorial Healthcare general website at www.marengohospital.org, found on the right hand side of this page and (2) in our registration and waiting areas at Compass Memorial Healthcare, Marengo Family Medical Clinic and Williamsburg Family Medical Clinic. You can also contact our Business Office at 319-642-5543 to request a copy of our Financial Assistance Policy and application free of charge.
How to Apply and Obtain Assistance
You may apply at any point in the scheduling or billing process by completing and submitting an application and providing income information. Any Financial Assistance Application whether completed in person, delivered or mailed in, will be forwarded to the Business Office for evaluation and processing. A Financial Assistance Application must be completed and submitted with the required documentation, no later than 240 days from the date of your first bill for the care received. The required documentation consists of a copy of your recent calendar year federal tax return, copies of your W2 and the last 4 pay stubs or vouchers from all employers for all persons claimed on your federal income tax return, and a copy of your last month checking and savings account bank statement.
If you need any help in applying, please contact our Business Office at 319-642-5543 between the hours of 8am-4:30pm Monday-Friday.
Return your completed application to:
Compass Memorial Healthcare - Business Office, 300 W. May Street, Marengo, Iowa 52301
Financial Assistance ApplicationHOSPTIAL FINANCIAL ASSISTANCE APPLICATION (English)
HOSPTIAL FINANCIAL ASSISTANCE APPLICATION (Spanish)