Patient Financial Services
FINANCIAL ASSISTANCE SUMMARY 
Massena Memorial Hospital recognizes that there are times when patients in need of care will have difficulty paying for the services provided. Massena Memorial Hospital’s PROUD program provides discounts to qualifying individuals based on income. In addition, we can help you apply for free or low-cost insurance if you qualify. Contact our Patient Financial Services representative at (315)769-4395 or visit the Patient Financial Services Office, room LL-2, for free, confidential assistance.
Who qualifies for a discount?
Financial assistance is available for patients with limited incomes and either no insurance, or underinsured.
Everyone in New York State who needs emergency services can receive care and get a discount if they meet the income limits.
Everyone who resides in New York State can get a discount on non-emergency, medically necessary services at Massena Memorial Hospital if they meet income limits. You cannot be denied medically necessary care because you need financial assistance.
You may apply for a discount regardless of immigration status.
What are the income limits?
The amount of the discount varies based on your income and the size of your family. If you have no health insurance, these are the income limits:
| Family Size | Annual Family Income | Monthly Family Income |
Weekly Family Income |
| 1 | Up to $30,630 | Up to $2,553 | Up to $589 |
| 2 | Up to $41,070 | Up to $3,423 | Up to $790 |
| 3 | Up to $51,510 | Up to $4,293 | Up to $991 |
| 4 | Up to $61,950 | Upt to $5,163 | Up to $1,191 |
| 5 | Up to $72,390 | Up to $6,033 | Up to $1,392 |
| 6 | Up to $82,830 | Up to $6,903 | Up to $1,593 |
What if I do not meet the income limits?
If you cannot pay your bill, Massena Memorial offers a payment plan to those patients that meet the income limits. The amount you pay depends on the amount of your income. We also offer flexible 12 month repayment plans to those who exceed the income limits, with a monthly minimum amount of $25/month repayment.
Can someone explain the discount? Can someone help me apply?
Yes, free, confidential help is available.
Call Patient Financial Services at (315)769-4395 or (315)769-4275.
If you do not speak English, someone will help you in your own language. The Financial Counselor may advise if you possibly qualify for free or low-cost insurance, such as Medicaid, Child Health Plus and Family Health Plus. If the Financial Counselor finds that you are not a candidate for low-cost insurance, they will help you apply for a discount. The Counselor will help you fill out all the forms and tell you what documents you need to bring.
What do I need to apply for a discount?
A completed PROUD program application
Copy of Income tax return for most current filing
Income Verification (i.e., current pay stub reflecting YTD earnings)
Current financial statements (i.e.: bank statement)
Verification of household expense for rent/mortgage, heat and lights
If applicable, current Medicaid denial
If you cannot provide any of these, you may still be able to apply for financial assistance.
What services are covered?
All medically necessary services provided by Massena Memorial Hospital are covered by the discount. This includes outpatient services, emergency care, and inpatient admissions. Charges from private doctors who provide services in the Hospital may not be covered. You should talk to private doctors to see if they offer a discount or payment plan.
How much do I have to pay?
The amount for an outpatient service or the emergency room starts from $0 for children and pregnant women, depending on your income. The amount for outpatient service or the emergency room starts from $15 for adults, depending on your income. Our Financial Counselor will give you details about your specific discount(s) once your application is processed.
How do I get the discount?
You have to fill out the application form. As soon as we have proof of your income, we can process your application for a discount, according to your income level. You can apply for a discount before you have an appointment, when you come to the hospital to get care, or when the bill comes in the mail. Send the completed form to Massena Memorial Hospital or bring it to the Patient Financial Services office. You have up to 90 days after receiving services to submit the completed application.
How will I know if I was approved for the discount?
Massena Memorial Hospital will send you a letter within 30 days after completion and submission of documentation, telling you if you have been approved and the level of discount received.
What if I receive a bill while I am waiting to hear if I can get a discount?
You cannot be required to pay a hospital bill while your application for a discount is being considered. If your application is turned down, the hospital must tell you why, in writing, and must provide you with a way to appeal this decision to a higher level within the hospital.
What if I have a problem I cannot resolve with the Hospital?
You may call the New York State Department of Health complaint hotline at 1-800-8504-5447.
