Billing Information

Thank you for choosing Golden Valley Memorial Healthcare (GVMH) for your family's healthcare needs. It is our privilege and honor to serve you and your loved ones. Please take a moment to read and understand this information. If you have questions at any time, do not hesitate to speak with any of our staff in Admitting or the Business Office.

Click here to view our Provider-Based Clinic Billing - Frequently Asked Questions...

Click here to view our Pricing Information.

We can be reached by phone Monday through Friday, 8 a.m. to 5 p.m. at 660.890.7125. Or feel free to stop in and speak with us in person during the same hours. 

Each patient, or responsible guarantor, bears responsibility for the payment of his or her balance, including bills incurred at one of our physician clinics, rehab facilities, or hospital.

What are your responsibilities?

First and foremost, you are responsible for giving us accurate and complete demographic and billing information. GVMH will file your claims, but it's very important to have accurate information, including subscriber and insurance information. If you have moved recently, changed your name or changed jobs, or have a new insurance plan, please be sure to bring that to our attention upon registration.

It's also important to know your benefits

Not all plans cover the same services. You must also be aware of which facilities and physicians are in your plan. These are usually described as in- or out-of-network providers. Out-of-network providers will typically be covered at a lower rate, meaning more due from the patient, if it is covered at all.

Each patient must also be aware of and comply with any pre-certification or prior-authorization requirements his or her insurance may have. If pre-certification requirements are not met, your procedure may be delayed or you could be responsible for up to 100 percent of the total charges.

Patients with insurance are expected to promptly respond

Patients with insurance are expected to promptly respond to any request from his or her plan so as not to delay payment. For instance, many plans will send a questionnaire to any member who sought treatment in an emergency setting. The form should be completed promptly, as payment will not be made until it's returned.

Responsibility matters

Though you may have insurance or feel that a third party should cover your treatment, the ultimate responsibility for the payment of your account is yours. GVMH can and will bill third party payers, and will make reasonable attempts to collect. If we are unable to properly collect from a third party payer, we may seek payment from the patient.

All co-pays and deductibles are due from the patient. No discounts will be given on co-pays or deductibles that are due, as the insurance company will have already taken the contracted adjustment. You may be asked to pay your portion at the time of service. For instance, emergency room (ER) co-pays are due at the time of registration. In some instances we may ask you to reschedule your non-emergent services if you cannot make your co-payment at that time.

Please remember that all patient balances not paid at the time of service are due upon receipt of the statement. If you are not able to pay in full when you receive your statement you must contact our office and make arrangements. Having an approved payment plan is required in order to keep your accounts in good standing. As always, financial assistance is available if you qualify (see below).

Organization matters

Patients should keep their medical bills organized and contact the facility or physician indicated on the bill for payment. When you seek medical care at one of our facilities, you may receive multiple bills. Each bill represents a separate set of charges. For example, if you come to the ER and the ER physician orders an x-ray, you will receive a minimum of three bills: one for the ER charges, one for the ER physician's charges, and one for the radiologist physician's charges. It's important for you to organize and pay each bill appropriately. In general, one facility cannot process or explain another entity's bill.

Plain Language Summary of GVMH Financial assistance Program

Golden Valley Memorial Healthcare (GVMH) gives financial help to people who qualify when they live in one of these counties:  Bates, Benton, Camden, Cass, Cedar, Henry, Hickory, Johnson, Morgan, Pettis, Polk, St Clair or Vernon.

We share details about our Financial Assistance Policy on our statements, collection letters, website, and through signs at registration. Also, the Business Office, Registration, Social Services and other departments give out applications and tell patients that help is available. To view our complete Financial Assistance Policy, please click here.

We use current federal poverty guidelines to decide how much help each patient will receive. We may not include services that are not medically necessary. We do not include drugs for treating cancer and co-pays. Co-pays will be due at time of service.

We provide care to anyone who comes to the Emergency Room regardless of whether they can pay or not. When there is not an emergency, we prefer the patients complete a Financial Assistance Program (FAP) application before they receive services.

If a patient is approved for financial help, that patient must set up a payment plan if the balance due cannot be paid in full. If a patient does not make the payments as agreed, we may send that patient’s accounts to a collection agency. To view our complete collection policy, please click here.

When a patient turns in an application for financial help, all of the following must be submitted:

80% Discount

  • Current Income Tax Return (form 1040 and schedule C, E or F if applicable)*
  • Payroll check stubs for past 30 days
  • Current Medicaid denial from your home county Family Services office
  • Copies of Social Security, Disability income, Unemployment, or other income
  • Copies of any other income (dividends, interest, rental income, child support, etc.)
  • Confidential Information Sheet/Application Form
  • Proof of primary residence (state-issued ID [driver’s license] or other requested documentation in the absence of an ID)

60% Discount

  • Current Income Tax Return (form 1040 and schedule C, E or F if applicable)*
  • Payroll check stubs for past 30 days
  • Copies of Social Security, Disability income, Unemployment, or other income
  • Copies of any other income (dividends, interest, rental income, child support, etc.)
  • Confidential Information Sheet/Application Form
  • Proof of primary residence (state-issued ID [driver’s license] or other requested documentation in the absence of an ID)

*Certain line items may be excluded 

When your application is complete, turn it in to the Financial Assistance/Credit Department at Golden Valley Medical-Clinton. You have 240 days (8 months) to turn in your application after you receive a bill. We will process the application within 30 days after you turn it in to us. The Financial Assistance Committee will review any application that includes these tax forms: Schedules C, E or F. The person who is responsible for the medical bill, his or her spouse and dependents count as part of the Family size. This is determined by IRS rules. 

Patients without insurance will be asked to make the following payments at the time of service:

     $25 per Emergency Room visit

     $10 per outpatient visit

     $10 per physician office visit

If you make a payment at the time of service, we will subtract that from the amount you owe after you receive a discount. If your payment and the discount make a credit, GVMH will refund the credit to you. If you owe on another account, GVMH will apply the credit amount to the other account.

Financial help will not be given to people who have or might have other ways of paying. The patient will be asked to use other sources of funding if available; for instance, applying for Medicaid, turning in all spenddown information to Medicaid, transferring to a VA hospital bed, settlements, etc.

GVMH will extend a 40% discount off of full charges to uninsured patients for medically necessary services. GVMH will apply the discount when we send the bill. If a patient is eligible for more than one discount (example: GVMH employee discount and FAP discount), GVMH will apply the discount that is most helpful to the patient, but no more than one discount.

GVMH will use the Federal Poverty Guidelines (FPG) to decide if a patient is eligible for financial help. Once we decide a patient is eligible for financial help, that patient will not be required to pay full charges. Patients whose family income is at or below 100% of the FPG are eligible to receive an 80% discount. Patients whose family income is at 101% to 250% of the FPG are eligible to receive a 60% discount off of full charges. Patients approved for Financial Assistance will not be required to pay more than what is generally billed to insurance payers.

The official GVMH FAP policy is available upon request from the hospital Business Office, Clinic Credit Department, FAP coordinators, and GVMH registrars, and is available at

Golden Valley Memorial Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.  

Download the Application for Financial Aid

Federal Poverty Guidelines

Federal Poverty Guidelines Annual Income Not Exceeding:

Family Size


  100% FPL  250% FPL 

























Additional Person



% of discount



Effective as of April 1, 2019.

Private pay

At GVMH, private-pay, or self-pay, patients (patients with no insurance) are given a 40 percent discount off of full charges. The remainder, however, is due from the patient.

Why am I getting this bill?

When you receive services at Golden Valley Memorial Hospital or one of our Golden Valley Medical Clinics, you may receive bills from multiple providers.  Since professional (physician) services and facility services are billed separately, and because GVMH partners with other physician providers to ensure we can provide the best care, it is necessary to send separate bills for the various services provided.  If you have any questions about a bill you receive, the best thing to do is call the customer service number on that bill. Please see the table below for a list of providers from whom you may receive a bill.

Organization  What they Bill Customer Service Phone Number
Ameripath Professional Pathology fees  866-450-7032
Golden Valley Medical GVM Professional fees  660-890-8458
Golden Valley Memorial Hospital Hospital Facility fees  660-890-7125
Quest Diagnostics Clinical Lab specimens / PAPS  800-759-2789
Reimbursement Technologies ER Physician fees  800-355-2470
St. Luke's Health System Hospitalist fees  816-502-7000
Virtual Radiologists (VRAd) Radiology reading fees for Medicare only *VRAd reads radiology tests only when GVMH radiologists aren't available.  888-806-4056


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