Clinic Community Care program -- Fairview Health Services - Fairview Health Services
 
Print
Clinic Community Care program
BodyImage_Consultation_Financial_Assistance

Getting help paying your clinic bills

Fairview's Clinic Community Care Program helps to cover care given in Fairview's free-standing clinics. It does not cover care received in hospitals which is covered under Fairview's Hospital Community Care Program.

Clinic Community Care reflects Fairview's mission to improve the health of the communities we serve. We treat all patients with dignity and respect, regardless of their ability to pay.

Before applying for the Fairview Clinic Community Care program, you may be asked to first apply for help with the county or state. If you currently have no coverage and are a Minnesota resident, please visit the MNsure website at www.mnsure.org or call 1-855-366-7873. If you are not a Minnesota resident, please contact your state's health care reform website. If you already have coverage and are not sure if you are eligible for additional coverage through the Affordable Care Act, please contact our office at 612-672-6724.

Fairview offers a variety of financial assistance programs.

Services covered

Clinic Community Care covers charges for most of our services. Here are examples of some services not covered by the program:

  • care that is not medically necessary (such as experimental treatments or care considered unnecessary by a Fairview doctor)
  • care that we do not offer at Fairview
  • services given at Fairview by independent contractors
  • physician services not billed by Fairview
  • services for people who do not live in Minnesota
     
Income guidelines

If your documented income is at or below 275 percent of the Federal Poverty Guidelines, you do not have access to health insurance and you have complied with the application process, you may qualify for the Clinic Community Care Program.

After paying the required deposit at your clinic visit, you will receive a discount on your bill. The annual maximum in discounts you may receive is $300 individually or $600 for a family.

Income guidelines by family size
Family sizeAnnual gross income
  1$32,093
  2$43,258
  3$54,423
  4$65,588
  5$76,753

Asset guidelines

Assets may not exceed $15,000 (household of one) or $25,000 (household of two or more). Retirement funds will be included as assets for all patients.

How to apply: step-by-step instructions

Thank you for your interest in Fairview’s Clinic Community Care program.

To apply for community care, read the instructions below and complete our Community Care Application Form.

Step 1: Complete and sign the form

  • List the names and birth dates for each family member applying for the program. If you do not list them on the form, they will not be included.
  • If your spouse is also applying for this program, both of you must sign the form.
  • Your family includes a spouse, dependent children and any person for whom you have legal guardianship.
     
Step 2: Attach these items to the form. We will keep your records confidential (private). Please include records for all adults in your household.

  • A copy of your most recent 1040 Federal Income Tax form. Do not include W2 forms.
  • Records of income over the past three months. (Example: pay stubs that show your year-to-date earnings.)
  • Copies of bank statements for all checking and savings accounts for the last 90 days. Include the last statement for any CDs (certificates of deposit).
  • Records of all retirement savings: employee pension plans, 401K plans, 403b plans, annuities, IRAs.
  • Optional: a letter explaining any recent events that might affect your ability to pay your medical bills.
     
Step 3: Return the form with the above records to the following address:

Patient Financial Services
Attn: Community Care
400 Stinson Blvd NE
Minneapolis, MN. 55413

Step 4: If you have applied for insurance coverage through MNsure or the Affordable Care Act, send the results of the apllication.

Community care may help pay for your Fairview bills. It is only used in times of need—it does not replace your insurance. If you or your spouse can get insurance through an employer, but you’ve chosen not to, then you cannot take part in this program.

You will keep receiving bills until we have your complete application. This includes the records listed above. If there are legal fees related to your account, you are not eligible for community care.
 
 Visit Other Fairview Sites 
 
 
(c) 2012 Fairview Health Services. All rights reserved.