Fairview Hospital Community Care program -- Fairview Health Services - Fairview Health Services
 
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Hospital Community Care program
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Getting help paying your hospital bills

The Hospital Community Care program covers charges for most Fairview hospitals. You may qualify for the Hospital Community Care program if your income is at or below 275 percent of the Federal Poverty Guidelines (see chart below).

Before applying for the Fairview Hospital Community Care program, you may be asked to first apply for help with the county or state. If you currently have no coverage and are a Minnesota resident, please visit the MNsure website at www.mnsure.org or call 1-855-366-7873. If you are not a Minnesota resident, please contact your state's health care reform website. If you already have coverage and are not sure if you are eligible for additional coverage through the Affordable Care Act, please contact our office at 612-672-6724.

Services covered

The Hospital Community Care program covers charges for most Fairview hospital-based services. It does not cover charges for:

  • care that is not needed (for example, care not approved by a Fairview doctor or trial treatments)
  • care that we do not offer at Fairview
  • services given at Fairview by independent providers
  • services not billed by Fairview
  • services related to transplant
     
The Hospital Community Care Program applies only to Fairview's hospital-based care. It does not include care received in free-standing clinics. This is covered under Fairview's Clinic Community Care Program. Fairview has a number of financial assistance programs.

If you do not know whether the care you are seeking is covered by Hospital Community Care, please ask us. If you have questions, call 612-672-6724 or (toll-free) 866-417-3560.

Income guidelines

If you qualify for the program, 100 percent of your bill will be paid. If you live out of state and qualify, 50 percent of your bill will be paid. You must comply with all the terms of the program when you apply, and we also ask you to follow the rules set by your insurance plan.

Income guidelines by family size
Family sizeAnnual gross income
  1$32,093
  2$43,258
  3$54,423
  4$65,588
  5$76,753
Asset guidelines

Assets may not exceed $15,000 (household of one) or $25,000 (household of two or more). Retirement funds will be included as assets for all patients.

How to apply: step-by-step instructions

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

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

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 includes a spouse, dependent children and any person for whom you have legal guardianship.
     
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. Include the last statement for any CDs (Certificates of Deposit).
  • Records of all retirement savings: employee pension plans, 401K plans, 403b plans, annuities, IRAs.
  • 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 insurance coverage through MNsure or the Affordable Care Act, send the results of the application.

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.
 
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