Application Guidelines

• Applications for Financial Assistance can be dropped off or mailed to the Financial Counseling Office located within the Business Office of Mary Greeley Medical Center, 1111 Duff Avenue, Ames, IA 50010. You can reach our Financial Counseling Office by phone at (515) 239-2119.
• Applications for Financial Assistance must be requested within 90 days of initial date of service for self-pay clients, or within 90 days of payment by insurance company.
• Applications for federal, state or other assistance programs which would serve as primary payer, such as Medicaid, Iowa Cares, Veteran's Administration, etc., must be completed before you will be considered for financial assistance. 
• To be eligible for assistance, you must first meet the minimum income requirements as established by Mary Greeley Medical Center. Our income requirement guidelines are listed below.
• Patients who have assets greater than $25,000, not including their primary home and one car, will not be eligible for financial assistance.
• You are responsible for providing all required information requested by our Financial Counselor within the application period. If you fail or refuse to furnish the requested information in the time requested, your application will be incomplete and we will not be able to extend financial assistance. We will verify income and other financial information by using financial statements, tax returns, bank statements, other documents and phone verification.
• Any misrepresentation or falsification of facts made by you in order to qualify for financial assistance will be cause for denial. If you are granted financial assistance and we find material provision(s) of the application to be untrue, the financial assistance will be withdrawn.

Exclusion Criteria

Assistance will not be granted if:

• The financial assistance application is not returned within 30 days 
• A hospital stay or portions of stay does not meet the Medical Necessity guidelines for hospitalization
• Any portion of an account is still payable by any third party
• The patient has medical/health insurance but fails to obtain pre-certification or seeks treatment at Mary Greeley Medical Center when Mary Greeley Medical Center is not a preferred provider
• Procedure is cosmetic

We have processes in place to quickly determine your eligibility. You will be notified in writing of approval or denial within 30 working days of receipt of a completed application. Notifications of denial will be accompanied by reasons for ineligibility.

The approval of assistance is honored for 180 days from the first service date covered. Applications for financial assistance will cover all legal dependents in the immediate family, providing all names, birth dates and social security numbers are listed on the application.

All patients under the age of 21 must apply for Medicaid or Healthy and Well Kids in Iowa (HAWK-I) program in order to be considered eligible for financial assistance. Refusal to pay premiums into the HAWK-I program will not be allowed as a basis for eligibility for financial assistance at Mary Greeley Medical Center.

If a student was claimed on his/her parent(s) tax returns for the prior year, the financial assistance application must be completed with the parent(s) financial information.