Monticello, GA · May offer charity care.
This is a government-owned hospital. It isn't bound by the federal nonprofit rule (IRC 501(r)), but many public hospitals have their own charity-care obligations under state or local law.
The short answer
This hospital writes off the full bill for households at or below 125% of the federal
poverty level, and discounts it up to 250%.
Work out where your own household falls below — the figures move with household size.
From the IRS Form 990 Schedule H filed for the tax year ending
09/2023 by
Jasper Health Services Inc, the organization that files for this hospital —
the most recent on file. Hospitals can change their policy between filings, and the form reports a
summary rather than the whole policy, so confirm with the billing office before relying on it.
What you would pay
Share of the federal poverty level
What this hospital reported
125% or less
Full write-off
125–250%
Discounted
Above 250%
No published discount — ask about a payment plan
Percentages are of the GA federal poverty guideline for your household size,
which changes each year. The estimator below converts them into dollars.
Check your own household
Hospital financial assistance is almost always based on household income compared with the
federal poverty level. What you type stays in your browser — it is never sent to us or to anyone else.
An estimate from published figures, not a decision. Only the hospital can approve an
application, and some policies also weigh savings, assets and residency.
How to apply
Apply even if the bill is months old. Nonprofit hospitals must accept financial
assistance applications for at least 240 days after your first bill — that is a
legal minimum, not a deadline, and many accept them later, including after a bill has gone to
collections. Ask rather than assume you have missed it.
Ask whether your bill already reflects assistance. It usually does not, even for
patients who would clearly qualify.
Gather what they will ask for — usually last year’s tax return or W-2,
recent pay stubs, and a photo ID. You do not need all of it to start.
If you are turned down, ask why in writing and whether you can appeal. A refusal is
often a missing document rather than a decision about your income.
For care you have not had yet, ask for a Good Faith Estimate in writing before you
schedule. If the final bill lands more than $400 above it you can dispute the difference
— see how the No Surprises Act works.
Ask in writing, if calling is hard
You do not have to phone. Copy this, fill in the blanks, and send it to the billing office by
post, email or the hospital’s patient portal.
To: Patient Financial Services, Jasper Memorial Hospital
Re: Account number ____________, patient ____________
I am asking to apply for financial assistance under your
financial assistance policy. Please send me the application
form and tell me what documents you need from me.
Please also place this account on hold while my application
is reviewed, and confirm in writing that you have received it.
I can be reached at ____________.
Nonprofit hospitals must post their financial assistance policy publicly, but they file it in
different places and we do not yet hold a direct link or a billing address for each one. Search the
hospital’s site for “financial assistance”, “charity care” or “patient
financial services”, or ask the billing office to send you the policy and the application.
If you do not qualify
Ask for an interest-free payment plan
Usually available regardless of income, and separate from financial assistance. Ask for one before
agreeing to anything a collections agency offers, and ask for the cash or self-pay price
— it is often well below the list price on the bill.
Nearby federally funded health centers
These charge on a sliding scale based on your household income, and see patients whether or
not you have insurance. Call ahead to ask what a visit would cost.
From HRSA’s public Health Center directory. These set fees on a sliding scale by
household income and cannot turn you away for inability to pay. They are not free clinics, and this list
does not include Georgia’s free and charitable clinics, which are listed separately by the Georgia
Charitable Care Network.