Charity Care Guidelines

WEIRTON MEDICAL CENTER NOTICE OF AVAILABILITY OF CHARITY CARE

Weirton Medical Center is required by law to give a reasonable amount of services without charge to eligible persons who cannot afford to pay for care.

If you feel that you might be eligible to qualify for the Charity Care program, please complete this Charity Care Application and return it along with the necessary supporting documentation to a Patient Account Representative located on the first floor of the Weirton Professional Building (located adjacent to the Hospital).

Due to the nature of the program, an application is not considered complete until all supporting documentation is presented. Should you have any questions or wish to speak to a Patient Account Representative, please do not hesitate to contact them directly at 304-797-6042, option 3.

Eligibility for financial assistance is based upon US Citizenship, West Virginia Residency and the U.S. Government’s Federal Poverty Guidelines. These guidelines are updated each year. You may qualify for financial assistance if your household income is at or below 200% of the current guidelines. The table below illustrates the guidelines and assistance offered:



Family Size/ Income Less than 200% of
Poverty Guidelines
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1/ $21,660

2/ $29,140

3/ $36,620

4/ $44,100

5/ $51,580

6/ $59,060

7/ $66,640

8/ $74,020

Each Addtl $7,480

WMC Discount Given 100%
Patient Responsibilty 0%

Additionally, any family member must qualify as dependents by IRS guidelines to be considered and must NOT have gross assets exceeding the following levels:

Family Size Asset Level
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1 $3,000
2 $5,000
Each additional dependent $ 500
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Application must be completed within 90 days of service being rendered, or anytime prior to services not yet rendered.

Documents that will be required as adequate proof of income and assets required to meet eligibility are listed below.

TAX RETURN FROM PREVIOUS YEAR
W2 FORM FROM PREVIOUS YEAR
CURRENT PAY STUBS
DENIAL LETTER FROM DEPT. OF WELFARE
COPY OF CHECKING ACCOUNT STATEMENT
COPY OF SAVINGS ACCOUNT STATEMENT
REAL ESTATE (EXCL PRIMARY RES)
SIGNED RELEASE AUTHORIZING WMC TO ACCESS CREDIT SCORE/HISTORY

The following documents may be required depending upon the circumstances of your individual situation:

UNEMPLOYMENT INCOME
WORKMAN’S COMPENSATION
PROOF OF SOCIAL SECURITY INCOME
ALIMONY
PROOF OF DISABILITY
PROOF OF SICK BENEFITS
PROOF OF PENSION
PROOF OF CHILD SUPPORT
PROOF OF JOB REGISTRATION OR
LETTER FROM DOCTOR STATING
UNABLE TO WORK
PROOF OF FOOD STAMPS
PROOF OF HUD
PROOF OF ANY DEPENDENT ON MEDICAL
CARD
SIGNED LETTER BY ANY PARTY AIDING
WITH LIVING EXPENSES

Weirton Medical Center reserves the right to deny or pend any applications based on insufficient proof of income. Eligibility will be conditioned upon verification of income and assets for the 12 months preceding the determination of eligibility. If you think you may be eligible for charity services, your request will be taken at the Patient Account Representative’s office between the hours of 9:00 a.m. and 3:30 p.m., Monday through Friday. If you have any questions, call 304-797-6042 and press prompt 3..