Patient Balance Policy Summary
Great River Health includes all services provided by Fort Madison
Community Hospital, Great River Medical Center, and Great River Physicians
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
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 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 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.