Request for Financial Assistance

Please bring proof of the following items to:

Harbor Beach Community Hospital

Business Office

210 S. First Street

Harbor Beach, MI 48441

Phone: (989)-479-3201

Hours: 8:00am to 4:30pm Monday through Friday

If you feel you would qualify for financial assistance please call

Karen Dallas, Business Office Director, at (989)479-3201 x 248

Financial Assistance Program Requirements:

  • Income:

    • Most Recent Check Stub from all employers

    • Social Security

    • Child Support

    • Interest

    • Pension

    • Workman or Unemployment Compensation

    • Any other income

  • Your Last 1040 (Federal Income Tax Return)

  • Drivers License

  • Insurance Cards

  • Birth Certificate or Social Security Card for all dependents

  • Evidence of Assistance (Medicaid) Denial

  • Completed FINANCIAL ASSISTANCE APPLICATION

Healthy Michigan Plan Program Information

  • Are age 19-64 years

  • Have income at or below 133% of federal poverty level under the Modified Adjusted Gross Income methodology

  • Do not qualify for or are not enrolled in Medicare

  • Do not qualify for or are not enrolled in other Medicaid programs

  • Are not pregnant at the time of application

  • Are residents of the State of Michigan

  • Michigan residents can enroll at any time online at www.michigan.gove/mibridges, by phone, or in person

  • If you would like help applying for the Healthy Michigan Plan, Please call Community Connections at 989-479-0346

You can view a summary of our Financial Assistance Policy by Clicking this link: PLAIN LANGUAGE SUMMARY

To view our complete Financial Assistance Policy, Please Click this link: COMPLETE POLICY

To view a list of Providers and Services not Covered by Policy. Please Click this link NOT COVERED

If you feel you would qualify for financial assistance please review our FINANCIAL ASSISTANCE FLOWCHART. If you have questions please call Karen Dallas, Business Office Director, at (989)479-3201 x248