What is Charity Care?
For emergency and other appropriate hospital-based services at EvergreenHealth Monroe, we provide free care and financial assistance/charity care to eligible patients on a sliding fee scale basis, with discounts ranging from 25% to 100%.
Who is eligible for charity care?
EvergreenHealth Monroe does not discriminate based on age, race, color, national origin, religion, sex, handicap or disability.
- Individuals and families with incomes within EvergreenHealth Monroe’s Poverty Guidelines which are based on the Washington State published poverty guidelines. Please refer to the EvergreenHealth Monroe’s Poverty Guidelines to determine eligibility.
- Individuals who have been screened and determined ineligible for Medicaid or state programs
- Individuals who are not involved in a situation where someone else has a legal responsibility to pay for the costs of medical expenses – for example, an auto accident.
- Individuals who are Washington state residents and are not entering Washington state solely for the purpose of seeking medical care. Exceptions to the Washington state residency requirement in the Charity Care Policy include:
~ all patients who have an emergency medical condition, consistent with applicable federal and state laws and regulations.
~ refugees, asylees and those seeking asylum who possess and can present United States Citizenship and Immigration Services (USCIS) documentation.
What does charity care cover?
Charity Care covers all medically necessary hospital services and services provided by other EvergreenHealth Monroe entities depending upon your eligibility.
It does not cover transportation costs, elective procedures or package price procedures.
How do I apply?
- Please verify your eligibility by referring to EvergreenHealth Monroe’s Poverty Guidelines
- Download and complete the charity care application.
- Include all supporting documents (pay stubs, checking & savings account statements, etc.)
- Proof of identification
- Sign and date form
- Return the completed form to:
Patient Financial Services Department
14701 179th Ave SE
Monroe WA 98272
If you have questions regarding EvergreenHealth Monroe’s Charity Care Program or the Confidential Financial form please contact EvergreenHealth Monroe’s charity line at 360.794.1495.
If English is Not Your First Language: Translated versions of the application form are available in Spanish upon request. EvergreenHealth Monroe also offers telephonic Interpreter Services in 180+ languages for onsite assistance.