As part of Excelsior Springs Hospital’s on-going commitment to our community, we offer discounts through our Financial Assistance Policy, established to help persons with no insurance or those who cannot afford to pay their medical bills after insurance has paid. Eligibility is determined by family size, income, and assets.
Enclosed you will find an application for assistance; if you wish to apply, please return the completed form to the hospital Business Office for the Financial Counselor, along with the following:
- Proof of residency–for example, a copy of a utility bill, credit card bill, etc. Personal correspondence (i.e. letter from a friend) is not acceptable.
- Copy of 4 recent pay stubs for each person in the household with any type of income. W-2’s are NOT acceptable as proof of income. If self-employed, please submit a complete copy of your current income tax return.
- Copy of proof of any other income the household receives – social security, pension, food stamps, child support, etc.
- Also, please include a copy of your most recent bank statement.
- You will be required to apply for assistance with Medicaid if we believe you qualify for benefits. The letter approving or denying your application will be needed with your application for assistance.
Please return the application and requested information to us within ten (10) days, so that a determination of eligibility can be made.
If you have any questions concerning this program or your account, please call (816) 629-6511.