Financial Assistance Program

The University of Vermont Health Network - Alice Hyde Medical Center is committed to treating all patients equitably, with dignity and respect regardless of your ability to pay.

What is the Financial Assistance Program?

The Financial Assistance Program at Alice Hyde Medical Center is designed to help people who are uninsured or underinsured and do not have the ability to pay. All patients receive medical care regardless of ability to pay. You must meet the eligibility requirements for financial assistance. You are expected to contribute to your care based on your ability to pay. This is not an insurance program, and is not meant to replace benfits that are, or could be, received from government supported programs.  It is the intention of Alice Hyde Medical Center to offer assistance to our most financially needy patients.  

Alice Hyde Medical Center provides financial assistance to all eligible NYS residents for emergency services in our primary service areas: Clinton, Franklin, Essex, and St. Lawrence Counties of New York State and for non-emergency medically necessary services, Alice Hyde Medical Center may extend financial assistance to other geographic areas on a case by case basis.  For more information, please refer to our Plain Language Summary of the Financial Assistance Program. 

Who is eligible?

Participants must meet the eligibility requirements (below) and comply with the guidelines.  This program is only for services provided by Alice Hyde Medical Center. 

Who is not eligible?

Those who exceed the income and other guidelines. 

The Financial Assistance Program does have limits to what it will cover. What isn't covered?

  • Services provided by physicians that do not work for Alice Hyde Medical Center.
  • Cosmetic Surgery
  • Charges not incurred at Alice Hyde Medical Center
  • Prescriptions

You should also check with the physician arranging for your hospital services to determine whether the services of any other physicians will be required for your care.  Your physician can provide you with the name, practice name, mailing address and telephone number of any physicians whose services may be needed.  Your physician will also be able to tell you whether the services of any physicians employed or contracted by Alice Hyde Medical Center are likely to be needed.  Alice Hyde Medical Center collaborates with some physician groups, such as radiologists and anesthesiologists, to provide services at the hospital.  You should contact these groups directly to find out which health plans they participate in, including: 

Adirondack Anesthesia Services
PO Box 2005
East Syracuse, NY 13057
(800) 289-3390

Apogee Physicians
PO Box 708728
Sandy, UT 84070
(800) 869-20395

Cold River Associates Pathology
PO Box 2828
Plattsburgh, NY 12901
(518) 561-6323

Emergency Department Physicians
Medical Services of Suffolk Count/Probill
PO Box 742405
Atlanta, GA 30374-2408
(800) 998-7578

North Country Precision Imaging Radiology
PO Box 6120
Waterown, NY 13601
(800) 924-2620

How and when do I apply?

Anyone wishing to apply should contact Alice Hyde Medical Center Patient Acccounting one of the following ways: 

  • Download Application
  • Phone: (518) 481-2241. We would be happy to provide you with an appointment to assist you in completing your application. 
  • Visit our office at 10 Third Street, Malone, NY. We are open Monday through Friday, 8:00am - 4:30pm. 

You can apply for the Financial Assistance Program any time prior to services being rendered. If you are applying after services have been rendered, you have a maximum of 120 days from the date of service to make application. Once you have received the application, you have 20 days to submit the completed form.  While your application is being processed, you may disregard any bills from Alice Hyde Medical Center until you have received a written decision on your application. 

Where do I go for government supported health insurance?

If you're unsure of how to obtain information about government supported health insurance, you can contact our office at (518) 481-2241. We will refer you to a certified counselor who can provide assistance in applying for Medicaid, Child Health Plus, and Essential Plans. 

How do I know if I qualify?

Up to 400% of the Federal Poverty Guideline

Family Size

Annual Monthly Income

Monthly Family Income

1

Up to $47,520

Up to $3,960

2

Up to $64,160

Up to $5,347

3

Up to $80,800

Up to $6,733

4

Up to $97,440

Up to $8,120

5

Up to $114,080

Up to $9,507

6

Up to $130,720

Up to $10,893

7

Up to $147,360

Up to $12,280

8

Up to $164,000

Up to $13,667

What documentation is required?

In order to determine the fee-scale amount and eligibility for financial assistance, the patient will have to provide the following documentation: 

  • All household income documents; pay stubs or W2 withholding form
  • Pension or retirement benefits
  • Rental income statements
  • Unemployment insurance benefits
  • Proof of the balance in your HSA/HRA if applicable
  • Verification of residency


What happens after I apply?

A determination will be based on information provided. You will be notified in writing of the determination. 

  • 100% - 150% approval: No balance due.
  • Partial approval: Those who have been accepted and who have income between 151% and 400% of the federal poverty guidelines will receive a partial sliding scale discount based on the reimbursement rate of the highest volume commercial payer.
  • Denial: Denials are based on information provided by you and will be specific as to what financial assistance eligibility the patient did not meet.

What if I am denied?

If you are denied financial assistance, a written explanation will be provided. You may appeal your denial and provide additional information in writing to:

Revenue Cycle Director
PO Box 729
Malone, NY 12953

Can I make payment on my balance after the Financial Assistance Program?

Yes, Alice Hyde Medical Center offers a patient payment plan or contract account in order to asssist you in fulfilling your financial oblications. Payment in full is preferred; however, financial arrangements are available.

If you have a financial hardship, please call our Patient Financial Services Office.  We will be happy to assist you with options. All payment arrangements must be approved and coordinated with the Patient Financial Sercices Office at 518-481-2241 after receipt of the first bill. 

Alice Hyde Medical Center Providers Participating in the Financial Assistance Program

Name Specialty
Banu, Dragos, M.D. Primary Care
Banu, Dimitrina, PA Urgent Care
Craig, Joshua, FNP Primary Care 
DeSnyder, Jerome, D.D.S. Dentistry
Dishman, Leonardo, M.D. Pathology
Dumitrescu , Claudia, M.D. Endocrinology
Fuentes, Francisco, D.D.S. Dentistry
Gravell, Brianne, FNP Primary Care
Griffin, David, PA Orthopedics
Gupta, Rahul, M.D. General Surgery
Haggarty, Marie, PA Orthopedics
Hess, Jill, PA Urology
Hunter, Linda, PA Urgent Care
Kim, John, M.D. Gastroenterology
Latreille, William, M.D. Primary Care
Lauzon, Kathleen, FNP Primary Care
Leffler, Stephanie, FNP Primary Care
LePage, Brenda, FNP Primary Care
Lovier, John, M.D. OB/GYN
Macelaru, Dragos, M.D. Orthopedics
McGonagle, Mary, FNP Primary Care
Medved , Vladimir, D.O. Pain Management
Nguyen, Duyen Hau (Nalie), D.M.D. Dentistry
Nguyen, Rita, D.D.S. Dentistry
Ordonez, Julia, M.D. Pediatrics
Petroski, Rayford, M.D. Urology
Reddy, Nikalesh, M.D. General Surgery
Reynolds, Derek, FNP Primary Care
Rizzo, Laura, FNP Primary Care
Robinson, Jessica, FNP Urgent Care
Sanchez, Myrna, M.D. Primary Care, Hematology, Oncology
Shah, Parth, D.D.S. Dentistry
Sheridan, Wilhelmina, FNP Primary Care
Tichenor, Louise, PA Pediatrics

Downloads

Financial Assistance Policy

Financial Assistance Policy Summary

Financial Assistance Program Application