Patient Balance Policy Summary

Great River Health includes all services provided by Fort Madison Community Hospital, Great River Medical Center, and Great River Physicians and Clinics.

Who is the guarantor?

The guarantor is the person responsible for paying the bill.

  • Patient under 18 – The guarantor is the parent who was present at the time of service. Great River Health does not take into consideration divorce decrees or other legal documentation regarding custody or parental responsibility in relation to children.
  • Patient 18 or over – The patient is the guarantor unless he or she is considered a dependent of someone else.
  • Deceased spouse – Spouse of the guarantor
  • Other – Anyone other than those listed above in cases of third-party party liabilities or Workers Compensation

Billing processes

Great River Health will file medical health insurance claims for patients if the guarantor provides insurance information within 45 days. If this information is not provided during this time, the full balance could become the responsibility of the guarantor.

We must have a signed Assignment of Benefits or Conditions of Treatment document. In some cases, insurance cannot be billed without the signed form. If the required form is not signed at the time of service, we will make two attempts to acquire a signed document. If the document is not obtained, the balance could become the responsibility of the guarantor.

Statements

Statements are issued when the guarantor is responsible for the balance. The first statement is itemized. Subsequent balance-forward statements are issued every 30 days.

Payment plans

Payment in full is required at the end of the 12th month from the date of the first statement. Payment plans for balances paid in 12 months:

  • Balances of $300 or less – $25 minimum monthly payment or the balance divided by the number of months available for the payment plan from the first statement date.
  • Balances over $300 – balance divided by the number of months available for the payment plan from the first statement date.

If the balance is not paid in full at the end of the 12th month:

  • The guarantor will use other resources to pay the balance in full.
  • The balance could be turned over to an outside collection agency. This includes accounts on which payments are being made but not meeting the required payment term above.

Automated payments will not be set up in our payment system unless the terms of the automated payment plan meet the requirements of our policy.

Other patient resources

  • Medical Expense Loan Program. Ask us for a brochure with details.
  • CareCredit Financing
  • Great River Health’s Financial Assistance Policy

Use of a collection agency

We will turn over accounts to an outside collection agency if:

  • We receive no payment on balances 120 days from the first statement dates. This includes balances in which insurance was not provided in a timely manner.
  • Payments are being made but not according to the terms above and the balance is not paid in full at the end of the 12th month.

To speak with a Great River Health financial counselor, please call 319-768-3625, option 2.