Assistance When You Need It
When those who live in our communities need medical care, financial concerns should not prevent them from receiving treatment. Memorial Hospital is committed to providing emergency and other medically necessary care by offering Financial Assistance to area residents that qualify.
All patients will be charged no more than amounts generally billed for any type of medical care. Patients who do not have insurance or have limited insurance benefits and receive treatment at our facility may be eligible for financial assistance under our financial assistance policy. Financial hardship is evaluated on a case-by-case basis.
To receive assistance, patients must complete the Financial Assistance Application and verification process within 240 days of their first bill.
To receive eligible services, you must complete the application and verification process within 240 days of discharge.
Eligible services are emergent and/or medically necessary healthcare services provided by Memorial Hospital at Gulfport, at any location, excluding office visits, cash package services, and elective services.
Contact a Financial Counselor
Do I Qualify?
To complete an application for the Financial Assistance Program at Memorial Hospital for emergent hospital services (does not include physician visits), partner with our Financial Counselor to determine if you meet the following criteria:
- Must be a citizen of the United States, a resident of Mississippi, and reside in the service area of the hospital. To verify your residency, you can provide one of the following:
- Current driver’s license
- Car tag registration
- Mortgage papers
- Lease or rental agreement
- Homestead exemption receipt
- Voter registration card
- Utility bill in your name
- Have family incomes at or below federal poverty level as determined by the U. S. Department of Health and Human Services. You will need information to verify your income which may include any of the following:
- A complete copy of your most recent Federal Income Tax Return, including W2s and or 1099 Form. For self-employed income, a schedule C must be included.
- Bank Statement, ACH Deposit: Social Security, disability, alimony, child support, or unemployment.
- If separated, please provide a notarized letter.
- If someone is helping with your expenses, such as food or rent, please have that person provide a letter of support.
- Most recent month check stubs that includes year-to-date income.
- Food Stamp benefit history.
- Proof of any income including income from life insurance policies, annuities, financial aid income, Trust Account income, and income from rental property.
How to Apply for Financial Assistance
Obtain a Financial Assistance Application
- Financial Assistance Application PDF (English)
- Financial Assistance Policy PDF (English)
- Financial Assistance Application PDF (Spanish)
- Financial Assistance Policy PDF (Spanish)
Visit our customer service area on the first floor of the main hospital near the main lobby.
Applications are taken and processed by Financial Counselors.
Where Do I Apply?
The Financial Counselor’s office is located on the first floor near the main lobby. We will make every effort to begin the application process while you or your family is in the hospital.
Upon receipt of a completed Financial Assistance application, a representative will review the information to determine if you qualify. We will contact you directly.
Should your application be incomplete, a representative will request the additional information. You will be provided 30 days from your application date to provide the necessary information. If the requested information is not received within that time period, your request will automatically be denied. Complete applications will be processed within 14 days of receipt.
Please Note: Any intentional false statements provided on your application will be cause for denial of any assistance.
Memorial Hospital Foundation also offers financial assistance. The Foundation was established in 1986 as a 501(c)(3) non-profit organization with a vision to develop relationships and financial resources to support the healthcare programs, projects and services of Memorial Hospital. The Foundation manages 20 funds that provide financial support to Memorial Hospital, our patients, and our employees. 100% of donations to the Foundation stay in our community and directly benefit the fund of our donors’ choosing. From medications for our cancer patients to the latest in advanced technology instrumentation, a gift to the foundation brings comfort and healing to our community. For more information on what the Memorial Hospital Foundation has to offer, call (228) 865-3419 or visit memorialfoundation.com.