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Payment Arrangements


Horn Memorial Hospital provides quality medical care 24 hours a day, seven days a week in response to the diverse medical needs of the communities it serves.

No one will be denied access to services due to their inability to pay, and there is a discounted/sliding fee schedule based on family size and income. Our staff will confidentially work with you to help you obtain financial assistance or coordinate a convenient payment plan.

If you have not completed the Financial Assistance Application, click here to open our Financial Assistance Application to print the application form.

Completed applications can be sent to the following:

Email:
fc@hornmemorialhospital.org

Mail:
Horn Memorial Hospital
Attn: Financial Counselor
701 E 2nd Street
Ida Grove, IA 51445

Payment requirements as of 01/01/2016 will be:

Balance Owed
$1.00 - $49.99
$50.00 - $100.00
$100.01 - $250.00
$250.01 - $750.00
$750.01 - $1200.00
$1200.01 - $2000.00
$2000.01 or greater
Minimum REGULAR Monthly Payment Required
Payment in full (100%)
33% of the monthly balance
25% of the monthly balance
10% of the monthly balance
8% of the monthly balance
7.5% of the month balance
5.5% of the monthly balance, to be paid in full within 18 months

Payments received that are below the minimum payment amount noted above will be returned to the patient with a letter of explanation.

Financial Assistance Policy


Financial Assistance Plain Language Summary


Sliding Fee Scale


Sliding Fee Scale for HPC


Financial Assistance Application


Authorization to Release Information


Please ensure you have the following compiled and completed:

SIGNED and completed application
Copy of current Federal Tax Return
Copies of last 3 pay/social security stubs
Copies of last 3 bank statements

If you have questions regarding financial assistance please contact the HMH Business Office at 712.364.3311.

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1. Mapleton

412 Main Street
Mapleton, IA 51034
712-364-3311

2. Ida Grove

701 East Second Street
Ida Grove, IA 51445
712-364-3311

3. Odebolt

300 South Maple
Odebolt, IA 51458
712-364-3311