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Financial Assistance

Hospitals in New Hampshire work hard to make quality health care available, affordable, and accessible to all, regardless of ability to pay. Southern New Hampshire Medical Center offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community getting the health care services they need.

If payment of your health care expenses could create a financial hardship for you, our staff will work with you to apply for financial assistance. Information you provide is confidential and is only reviewed by staff processing your application.

There are many factors taken into consideration when determining eligibility. We also may be able to connect you with other resources for which you may qualify. As part of the financial counseling application process, the hospital will assess your potential eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid. If it is determined that you may be eligible for one of these programs, the hospital may assist you in the application process. You will be required to supply the financial or medical documentation that is necessary to secure such insurance coverage.

Charitable Care Policy
Southern NH Medical Center is committed to providing charitable care to persons who have health care needs and are uninsured, underinsured, ineligible for governmental programs and are otherwise unable to pay for medically necessary care based on their individual financial situations. Read more about our Charitable Care Policy

Criteria Categories for Financial Assistance

Exclusions for Eligibility
Cosmetic procedures and infertility services are not eligible for financial assistance. All other elective or non-emergent services are covered at the discretion of the health provider or hospital.

The following statewide programs are also available: How to Apply for Financial Assistance
Call our financial counselors at (603) 577-2205 or 577-2241. A financial counselor will advise you and investigate other sources that might provide financial assistance.

Complete a financial assistance application. Click to open and print a copy of the application. You can also pick it up at the Financial Assistance Office at Southern New Hampshire Medical Center, or call us at 577-2205 or 577-2241 to request that one be mailed to you. Submit the application with the following documents:
  • Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year’s W-2 forms.
  • Copies of the three (3) most recent, consecutive paycheck stubs or a statement from your employer on company letterhead.
  • Copies of three (3) most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)
  • Copies of unemployment or disability compensation benefits (include start date)
  • Copies of pension benefits
  • Copies of Social Security income (yearly benefit statements, copy of check or direct deposit)
  • Copy of Food stamp allocation
  • Copy of rental assistance from the city
  • Copies of notices from Department of Health and Human Services
  • Copy of Worker’s Compensation (indicate date of injury)
  • Proof of rental income - # of units (occupied-unoccupied), do you live in the rental units?
  • Copies of child support paid and/or received
  • Please note that elective procedures may not be considered for assistance
Please use this checklist to be sure we have all the information we need to quickly and correctly process your application. We may ask you for additional information about your credit evaluation and income tax return. The information you provide is confidential. Please submit the above documents through postal service mail or in person; do not email copies as we cannot guarantee the security of your personal information. A financial counselor is available to assist with the application process during normal business hours (Monday through Friday 9:00am-4:30pm). The financial counseling office is located at The Medical Center main entrance. After hours, a drop box is available for deposit of documents at this location.

You will continue to be financially responsible for any services you receive until we have learned whether you qualify for help. If you have not heard from us within 30 days after returning your application, or you need help in understanding it, please call 603-577-2205.

Price Estimates for Medical Services
Southern New Hampshire Health System makes resources available which help patients understand the price of medical care.

How to Apply
-Download this financial assistance application, print a copy, and follow the instructions on the application.

-You can also pick it up at the Financial Assistance Office at Southern New Hampshire Medical Center, or call us at 577-2205 or 577-2241 to request that one be mailed to you.

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