The Bond Wellness Center

Financial Grant Program

MCH and Health Services providers will provide care to all those in need regardless of the ability to pay. We also recognize that some patients may need help to pay their hospital and/or physician bills.

Do You Need Help With Your Medical Bill?

You may be able to get financial help from Monadnock Community Hospital and possibly other Health Access Network providers

Assessing Your Need

Inpatient: During your hospital stay the social worker may ask you whether you have any financial concerns. We would encourage you to discuss this with the social worker so that appropriate referrals can be made. If you have been seen by a social worker you may request a visit.

Outpatient: Anytime you receive services at MCH and Health Services you will be asked about insurance information. It is important to let that person know if you have any concerns so that they can make appropriate referrals.

How Can the Financial Grant Coordinator Help You?

  • Assist patient in completing application (download application)
  • Determine eligibility
  • Help patient apply for public assistance.
  • Identify other community programs that you might be eligible for.
  • Determine eligibility for NH Health Access
  • If you have already received a New Hampshire Health Access card from another facility, please call Rebecca Stone at 924-1717.
  • Assist with application for NH Healthy Kids (download application) and call us to set up an appointment.

The Following are some General Guidelines about the Program:

Eligibility Requirements:

  • Eligibility will be based on financial need at the time of application
  • All resources of the family are considered
  • Documentation will be requested and required to establish eligibility.

To find out if you or your household qualifies, you must give us proof of your income. Please fill out the attached application and sign it. Then, please send us that application and a COPY of each of the following for your household:

  1. Complete copy of your most recent Federal Income Tax Return and all schedules. If you didn’t file a tax return last year, please complete IRS4506T. If you did file and do not have a copy, please sign and complete a 4506T.
  2. Last year’s W-2 forms
  3. Copies of the three (3) most recent, consecutive paycheck stubs or a statement from the employer. (Download Income Verification Form)
  4. Copies of the three (3) complete, most recent bank statements (e.g. savings, checking, money market, IRA, 401K, etc). If you do not have any accounts please complete (Download no bank account verification form). Please note: this form must be notarized.
  5. Copies of unemployment or disability compensation benefits statements
  6. Copies of pension benefits stubs
  7. Copies of social security income
  8. Copies of Food Stamp allocation
  9. If you currently have no income, please complete (download no income verification form). Please note: this form must be notarized.
  10. Copies of government assistance notices (including Department of Health and Human Services).

Please use the above list to ensure we have all the information we need to quickly and correctly process your application. We may ask you for additional information about your credit evaluation and income tax return. The information you provide is confidential.

You will continue to be financially responsible for any services you receive until we have determined whether you qualify for help.

The Financial Grant Program Does Not:

  • Replace health insurance. This program is not insurance.
  • Cover cosmetic surgery or any elective procedures determined by your provider.

“No Shows”

  • FGP will not be applied to no-show charges.

Accounts in Collections

  • If an account has already been transferred to the collection agency, the FGP discount will not be applied.

Billing

  • During the application process the patient will still be responsible to set up a payment plan by calling our Financial Counselor at 924-4699 ext 4281. If the patient is eligible for discount, the discount will be applied 6 months retroactively for open balances from the date of determination. Refunds will not be issued for payments made during that time.

For more information, please contact:

Rebecca Stone
Financial Grant Program Coordinator
452 Old Street Road
Peterborough, NH 03458
Ph. (603) 924-1717
Fax. (603) 924-1709
Email: rebecca.stone@mchmail.org