Patient Financial Support Application

Eaton Rapids Medical Center is committed to meeting the needs of the residents of its defined service area by offering a sliding fee scale to all income-eligible uninsured or underinsured patients based on annual household gross income. Under no circumstances would ERMC withhold emergency medical care to any individual based upon insurance status, ability to pay, or any other criteria. Amounts charged for emergency and medically necessary medical services to patients eligible for Financial Assistance will not be more than the amount generally billed to individuals with insurance covering such care.

ERMC offers a Financial Assistance Program (FAP) to reduce the burden of medical expenses for patients who demonstrate financial need. The FAP provides discounted care based upon family income and size in relation to Federal Poverty Level guidelines.

Policy Statements
The Reimbursement Management Team is responsible for the following actions: It is the policy of ERMC to offer financial assistance to patients who are unable to pay their hospital bills due to difficult financial situations. An ERMC Financial Counselor (517)663-9477, Collection Clerk (517)663-9407, or staff members with authority to do so, may offer financial assistance. The Patient Accounts Supervisor will review individual cases and make a determination of financial assistance that may be offered. ERMC determines the need for financial assistance by reviewing the particular services requested or received, insurance coverage or other sources of payment, a person's historical financial profile and current financial situation. This method allows for a fair and accurate way to assist patients who are experiencing financial hardship. Partial and/or full financial assistance will be granted based on the individual's ability to pay. Eligible individuals include patients who do not have insurance and patients who have insurance but are underinsured. Patients must cooperate with any insurance claim submission and exhaust their insurance or potential insurance coverage before becoming eligible for financial assistance.

Purpose & Scope
This policy serves to establish and ensure a fair and consistent method for the review and completion of requests for charitable medical care to our patients in need.

  • To specify the criteria for identifying individuals that are eligible to receive services rendered by ERMC either free of charge (i.e.: 100% discount) or at partially discounted rates.
  • Patients qualifying under the Financial Assistance Policy (FAP) will be exempt from liability for the determined discount.
  • The FAP applies Federal Poverty Guidelines, adjusted for household size, to identify patients with a documented inability to pay for either the entirety or for a portion of the services rendered. Individuals that receive a partial discount are liable for balances not discounted and will be subject to collection efforts by ERMC for the balance due after discount.
  • The FAP does not apply to elective or cosmetic services or services that are not medically necessary. Patients are encouraged to inquire prior to the rendering of services as to whether or not a service qualifies for the FAP.

General Requirements

  • Financial assistance will be granted only after the submission of a signed Patient Financial Assistance application by the patient, relative, legal guardian, and power of attorney.
  • Neither ERMC nor its agents shall pursue collection actions against patients for amounts qualifying for financial assistance.
  • Applicants may qualify for financial assistance under the following circumstances.
  • A. Federal Poverty Guidelines: The patient's and/or guarantor's income is equal to and there are no other assets available to the patient which could be used in the settlement of ERMC charges. A principal residence generally would not be considered an available asset in this regard.

    B. Medicare Beneficiaries: Deductibles and coinsurances due from Medicare beneficiaries can be eligible for discount under the FAP assuming the patients submits an application and qualifies.

    C. A patient who applies for financial assistance will receive a written notice of the determination of ERMC within 60 days of submission of the written application and all required supporting documentation.

  • Once ERMC determines the patient to be eligible for financial assistance, this determination MAY be in effect for 6 months from the date of the initial determination. If approved for financial assistance, any and all changes regarding income, insurance status, family size, etc. must be reported to ERMC.
  • ERMC shall not discriminate on the basis of race, color, national origin, ethnicity, religion, creed, sex, sexual orientation or age in its application of policies concerning the acquisition and verification of financial information, and eligibility for financial assistance.
  • The patient and/or guarantor must cooperate fully with ERMC to explore and obtain all possible alternative insurance coverage, ie: Medicaid, auto insurance settlements, Social Security, etc.
  • The patient and/or guarantor must provide proof that application has been made and coverage denied by Michigan Medicaid.

Reason's for Denial
ERMC may deny financial assistance for a variety of reasons including, but not limited to:

  • Excessive income
  • Excessive asset level
  • Patient is uncooperative or unresponsive to reasonable efforts to work with the patient
  • Incomplete Financial Assistance Application despite reasonable efforts to work with the patient
  • Pending insurance or liability claim
  • Withholding insurance payment and/or insurance settlement funds, including insurance payments sent to the patient to cover services provided by ERMC, and personal injury and/or accident related claims
  • Supplying false or incomplete information on the Financial Assistance Application.


  • Patients will be made aware of the availability of the Financial Assistance Policy through the posting of signs in all registration areas throughout ERMC and in the Rural Health Clinics.
  • ERMC shall make available copies of the Financial Assistance Policy application at any and all registration areas where patients access ERMC services.
  • Inpatient admissions to the facility will be notified of the Financial Assistance Policy prior to discharge by the discharge planner. The financial counselor (517)663-9477 will be available for any questions or as an additional resource during normal business hours.
  • ERMC will attempt to inform the public of its Financial Assistance Policy through the ERMC website ( and/or use of public announcements, paid advertising, etc.

ERMC will assist any patient with completion of an application for Financial Assistance and, whenever possible, with applications for other programs such as Medicaid, Medicare Part D, etc. A patient may obtain confidential and compassionate assistance at the ERMC Financial Counselor's office located at 1500 S Main St, Eaton Rapids, MI or by calling (517) 663-9477. It is preferable that applicants call in advance and make an appointment and that they arrive with all requested documentation and the application completed to the best of their ability in advance.

Documentation and Audit

  • Each financial assistance application shall be accompanied by patient documentation of all efforts made by ERMC to determine eligibility.
  • Financial Assistance application documentation shall be kept on file for a period of 7 years. After 7 years all paperwork will be permanently destroyed.
  • For federal Health Resources and Services Administration reporting, ERMC will not claim discounts provided to individuals with income in excess of 200% of FPL.

Decision of Eligibility
The Patient Accounts Manager will make the final determination of eligibility for financial assistance using the above policy. This information will be recorded in writing in the appropriate section of the application forms.

Collection Activity
ERMC will not engage in extraordinary collection actions before it makes a reasonable effort to determine whether a patient is eligible for financial assistance under this Policy. Collection activity will proceed based on a separate Collection Policy.

If a collection agency identifies a patient as meeting ERMC's financial assistance eligibility criteria, the patient's account may be considered for financial assistance. Collection activity will be suspended on these accounts and ERMC will review the financial assistance application. If the entire account balance is adjusted, the account will be returned to ERMC. If a partial adjustment occurs, the patient fails to cooperate with the financial assistance process, or if the patient is not eligible for financial assistance, collection activity will resume.

ERMC staff will uphold the confidentiality and individual dignity of each patient. ERMC will meet all HIPAA requirements for handling personal health information.


PDF: Patient Financial Assistance Policy

PDF: Patient Financial Support Application