Financial Assistance

(Available in Spanish)

At Golden Valley Memorial Healthcare, we provide information about financial assistance through statements, collection letters, our website and signage at registration areas. Our Business Office, Registration Team and Social Services staff are available to help patients apply for assistance and understand their options.

• Financial assistance is determined using current federal poverty guidelines.
• Non-medically necessary services and specific items (like cancer drugs and copays) are typically excluded from assistance.

• Care is provided to all patients in the emergency room, regardless of payment ability.
• For non-emergency services, patients are encouraged to complete a Financial Assistance Program (FAP) application prior to receiving care.

• Approved patients must establish a payment plan if they cannot pay the balance in full. GVMH offers a six-month payment plan. 

• Zero percent financing is also offered through our partner vendor Clear Balance, with varying payment schedules available.

• Failure to adhere to the payment plan may result in accounts being sent to a collection agency.

To qualify for financial assistance, applicants must submit the following documentation:

For 100% discount

• Current Income Tax Return (form 1040 and schedule C, E or F if applicable)
• Payroll check stubs for the past 30 days
• Current Medicaid denial letter
• Documentation of other income (e.g., Social Security, Disability, Unemployment)
• Confidential Information Sheet/Application Form
• Proof of primary residence (state-issued ID or equivalent)

For 80% discount

• Current Income Tax Return (form 1040 and schedule C, E or F if applicable)
• Payroll check stubs for the past 30 days
• Documentation of other income (e.g., Social Security, Disability, Unemployment)
• Confidential Information Sheet/Application Form
• Proof of primary residence (state-issued ID or equivalent)

Once complete, turn your application into Patient Accounts within 240 days of receiving a bill. The processing time is about 30 days.

Payments at the time of service for uninsured patients are:

• $25 per emergency room visit
• $10 per outpatient visit
• $10 per physician office visit

Payments made will be deducted from your total after any discounts. Any credits will be refunded or applied to other accounts as needed.

• Patients with incomes at or below 100% of Federal Poverty Guidelines (FPG) may receive a 100% discount.
• Those with incomes between 101% and 250% are eligible for an 80% discount.
• Financial help is not available if there are other funding options available, such as Medicaid or VA services.

A 40% discount off full charges for medically necessary services will be automatically applied.

The official Golden Valley Memorial Healthcare FAP policy is available upon request from the Business Office, Patient Accounts, FAP coordinators and our registrars. You may also download and view the policy here.

GVMH does not discriminate based on race, color, national origin, age, disability, or sex.

For more details, you can request the complete policy from the hospital’s Business Office or visit gvmh.org.