Clipboard is sitting on top of a table with paperwork, a stethoscope, and pen
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 Plain Language Summary
Financial Assistance Application
Authorization to Release Information
Please ensure you have the following compiled and completed:
SIGNED and completed application
SIGNED and completed applicationCopy of current Federal Tax Return
Copies of last 3 pay/social security stubs
If you have questions regarding financial assistance please contact the HMH financial counselor at 712.364.7219.
