Patients who are unable to pay their hospital bill may qualify for certain financial assistance programs that are available. If you are unable to pay your hospital bill, you should contact our Patient Business Services department at 251-435-3541. We will provide a Statement of Truth form, which you should complete and sign. In addition, we will provide you with a Financial Assistance Review Check List.

You need to furnish the requested financial information and supporting documents, which should demonstrate your financial need and support your income, expense, asset and debt situation. All information will be reviewed by our Financial Assistance Committee, and qualification with our financial assistance criteria will be determined. Qualifying patients will be notified of the financial assistance determination and dollar amount, if any.

You can download and complete the Assistance Letter and the Financial Disclosure forms.
Assistance Letter.pdf
Financial Disclosure Form.pdf

Please furnish the requested financial information and supporting documents.