Check Eligibility - Black River Memorial Hospital Financial Assistance

Financial Assistance
Eligibility Checker

Thanks for using our Eligibility Checker for Financial Assistance! Please answer the following 2 questions to see if you are eligible for a discount on your Black River Memorial Hospital bills.

Including yourself, how many people are in your household?(Required)
Please enter a number from 1 to 10.
Does anyone in your household have income from a job?(Required)

Yes

No
What is your total MONTHLY household income before taxes?(Required)
This could include employment, Social Security, alimony, child support, retirement, unemployment benefits, per capita income, rental income, etc.
Please enter a number from 0 to 1000000.

Would you like information about our Financial Assistance Program emailed to you?(Required)
If you would like to receive more information about our Financial Assistance Policy or applying online for financial assistance, please provide your name and email.

Yes

No
Contact Info(Required)
Please provide your name and email.
First Last
Email(Required)
Email Address

Thank you! We have the information we need to determine if you may qualify for Financial Assistance at Black River Memorial Hospital.

Please click below to see your results.
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GrandTotal Income
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Family Additionals
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Family Additional Total 5380
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Yearly Rate 15060
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Calculated % FPL
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FPL for Program
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226 to 250% Discount 75%
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251 to 275% Discount 50%
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276 to 300% Discount 25%
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Total Bill Plain Format
Comments
This field is for validation purposes and should be left unchanged.

Financial Assistance Eligibility Checker

Financial Assistance
Eligibility Checker