Financial Assistance

Hospitals in New Hampshire work hard to make quality health care available, affordable, and accessible to all, regardless of ability to pay. New London Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to receiving health care services. If payment of your health care expenses could create a financial hardship for you, our staff will work with you to apply for financial assistance. Information you provide is confidential and is only reviewed by staff processing your application.

Even if you're uncertain about your eligibility, please feel free to call us for an application. Many factors are taken into consideration when determining eligibility. We also may be able to connect you with other resources for which you may qualify.

As part of the financial counseling application process, the hospital will assess your potential eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid. If it is determined that you may be eligible for one of these programs, the hospital will assist you in the application process. You will be required to supply the financial or medical documentation that is necessary to secure such insurance coverage.

Criteria Categories for Financial Assistance

  • Family income, in relation to federal poverty guidelines
  • Assets (e.g. home, bank account, and stocks)
  • Any additional financial hardship
  • You must be receiving medically necessary care.

Exclusions for Eligibility

Cosmetic procedures and infertility services are not eligible for financial assistance. All other elective or non-emergent services are covered at the discretion of the health provider or hospital.

Financial Assistance Programs available at New London Hospital

New London Hospital also participates in several statewide programs:

How to Apply for Financial Assistance

Please call New London Hospital Financial Couseling in the Revenue Cycle Services Department at 603-526-5292. A financial counselor will advise you and investigate other sources that might provide financial assistance.

Complete a financial assistance application. You may print it from our web site, or it is available at the Financial Counseling office on the main level of the hospital.

Submit the application with the following documents:

  • Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year's W-2 forms.
  • Copies of the three most recent paycheck stubs or a statement from the employer
  • Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)
  • Copies of unemployment, disability compensation benefits statements
  • Copies of social security or pension benefits income
  • Copy of food stamp allocation
  • Copies of government assistance notices, such as Social Security, Disability and Medicaid

The above is the list that is required for the NHHAN application. Add any others if necessary for other programs. Also include notes on whether there are special instructions for sending these documents to the hospital, and provide a mailing address.

Please submit the above documents through postal service mail or in person; do not e-mail copies as we cannot guarantee the security of your personal information.

Notification

Provide information on how patients will be notified that their application has been approved or denied and when. If denied, offer guidelines for next steps or an appeal process if you have one.

Please note that financial assistance approval is valid for 6 months and a new application will have to be submitted after that time.

Making payments

We know that health care costs can come up unexpectedly. Whether you are insured or uninsured, whether or not you qualify for financial assistance - we understand that you may have difficulty paying your health care costs in full at the time of service or in a lump sum. We are happy to work with any patient to set up a payment plan.

Contact
Financial Advisor
PO Box 2150
New London, NH 03257-2150
603-526-5292

We welcome your e-mail about your account but due to our dedication to keeping your information secure we will respond to any e-mails by regular US postal mail.