Financial Assistance

Mayo Regional Hospital (MRH) has a Financial Assistance Policy that provides patients who qualify with full or partial discounts on their medical bills from MRH. To seek financial assistance, patients must complete an application as summarized below. Please see our Financial Assistance Policy or contact Mayo Regional Hospital, Patient Financial Services Counselor, for more information:

Mayo Plain Language Summary

To Qualify

Financial assistance is available to patients that meet income guidelines.  It will cover, as shown below, all or part of emergency and medically necessary care. Cosmetic and elective services may not be eligible for assistance.  Generally, financial assistance is available for patients whose family incomes are at or below 225% of the Federal Poverty Guideline (FPG).

Amount of Financial Assistance

A 65% discount is available for patients with family incomes above 175% and at or below 225% of FPG. A 100% discount (free care) is available for patients with family incomes at or below 175% FPG. A patient eligible for financial assistance will not be billed more than amounts generally billed to Medicare for emergency or medically necessary care.

2018 FEDERAL POVERTY GUIDELINE (FPG) TABLE
HOUSEHOLD SIZE 2018 FPG UP TO 175% OF FPG 176% TO 225% OF FPG
1 $12,140 $21,245 $27,315
2 $16,460 $28,805 $37,035
3 $20,780 $36,365 $46,755
4 $25,100 $43,925 $56,475
+/Person $4,160 $7,560 $9,720
Discount  100% 100% 65%

How to Apply

Patients seeking financial assistance must complete an application and may be asked to provide certain documents. You may obtain free copies of Mayo Regional Hospital’s PATIENT FINANCIAL ASSISTANCE APPLICATION online, within the patient and visitors/patients/free care section. You can also get free paper copies in person or by mail, at any registration area in the Hospital or our doctor’s offices, or by visiting or contacting Mayo Regional Hospital:

In Person
Mayo Regional Hospital Front Desk, Patient Financial Counselors office, Registration areas.

By Phone
(207) 564-1615 or (207) 564-8401

By Mail
Mayo Regional Hospital
ATTN: Patient Financial Counselor
897 W Main St.
Dover-Foxcroft, ME 04426

If you need more information about our Financial Assistance Policy or assistance with the application, you may visit Mayo Regional Hospital’s  Patient Financial Counselor from Monday – Friday (except holidays), 8:00 am – 4:30 pm. You may also call the above phone numbers.

To learn more about our Billing Policy, Billing and Collections Policy 8/18

Summary of Financial Assistance forms:

Discount Policy & Payment Arrangements

Discount Policy 8/18

Plain Language Summary:
Mayo_Plain_Language_Summary

Financial Assistance Policy:
Financial Assistance Policy 8/18

Financial Assistance Application:
PATIENT FINANCIAL ASSISTANCE APPLICATION

Collection and Billing Policy:
Billing and Collections Policy 8/18

Maine Care Application:
MaineCare Application Rev 1.4