About

Clinic Community Care program

The Clinic Community Care Program helps to cover care given in Fairview's free-standing clinics. It does not cover care received in hospitals which is covered under Fairview Hospital Community Care Program.

Clinic Community Care is part of Fairview's mission to provide quality medical services to everyone in our community. We treat all patients with dignity and respect, regardless of their ability to pay.

Before applying for the Fairview Clinic Community Care program, you must first apply for help from the county. Learn more about state and county programs for which you may be eligible. You must provide your county approval or denial in writing to Fairview when you apply for Community Care. We will determine if you qualify for Community Care.

Services covered

Clinic Community Care covers charges for most of our services. Here are examples of some services not covered by the program:

• care that is not medically necessary (such as experimental treatments or care considered unnecessary by a Fairview doctor)
• care that we do not offer at Fairview 
• services given at Fairview by independent contractors 
• physician services not billed by Fairview 
• services for people who do not live in Minnesota
   

Income guidelines

If your documented income is at or below 275 percent of the Federal Poverty Guidelines, you do not have access to health insurance and you have complied with the application process, you may qualify for the Clinic Community Care Program. After paying the required deposit at your clinic visit, you will receive a 100% discount on your bill. The annual maximum in discounts you may receive is $300 individually or $600 for a family.

Income guidelines by family size:

 
How to apply

To apply for community care, read the instructions below and complete our Community Care Application Form. 
 

Instructions

Thank you for your interest in Fairview’s Community Care program.

Step 1: Complete and sign this form.

• List the names and birth dates for each family member applying for the program. If you do not list them on the form, they will not be included.
• If your spouse is also applying for this program, both of you must sign the form.
• Your family size is the number of supported family members in your household. This should be the same as what you’ve listed on your tax return.

Step 2: Attach these items to the form. We will keep your records confidential (private). Please include records for all adults in your household.

• A copy of your most recent 1040 Federal Income Tax form. Do not include W2 forms.
• Records of income over the past three months. (Example: pay stubs that show your year-to-date earnings.)
• Copies of bank statements for all checking and savings accounts for the last 90 days.
• For people age 62 and older: records of all retirement savings.
• Optional: a letter explaining any recent events that might affect your ability to pay your medical bills.

Step 3: Return the form with the above records to the following address:

Patient Financial Services
Attn: Community Care
400 Stinson Blvd NE
Minneapolis, MN. 55413

Step 4: If you have applied for Medical Assistance (help from the state or county), you will receive a letter of approval or denial. When this letter arrives, send a copy of the letter to your community care contact at Fairview. The letter will help decide if you get help from our program.

Community care may help pay for your Fairview bills. It is only used in times of need—it does not replace your insurance. If you or your spouse can get insurance through an employer, but you’ve chosen not to, then you cannot take part in this program.

You will keep receiving bills until we have your complete application. This includes the records listed above. If there are legal fees related to your account, you are not eligible for community care.