Billing > Financial Assistance

Financial Assistance

Welcome to the Financial Assistance segment of the Brooks Memorial Hospital website. Brooks Memorial Hospital has a long tradition of providing effective stewardship for the health care needs of the community and visitors in our service area. It is the policy of Brooks Memorial Hospital to provide these services regardless of race, creed, sex, national origin, age, handicap, ability to pay, or any other classification or characteristic. Based on this mission Brooks Memorial Hospital is establishing a “Financial Assistance” policy to address the health care needs of those individuals who can demonstrate an inability to pay full charges for “Medically Necessary” services. To apply for this program it is necessary to complete a Financial Assistance Application. The application can be printed by accessing the link below, at any registration point in the Hospital, the Business Office, Cashier, or contacting a Financial Counselor at (716) 363-7219 or 7221. The completed applications, with supporting documentation, can be brought in to the Business Office or mailed to:

Brooks Memorial Hospital

ATTN: Financial Counselor, Business Office

529 Central Avenue

Dunkirk, NY 14048

FINANCIAL ASSISTANCE INFORMATIONAL BROCHURE (pdf)

FINANCIAL ASSISTANCE APPLICATION (pdf)

The policy is in compliance with Federal, State, and Local laws and regulations, JCAHO requirements, and other third party contractual obligations and to insure the continued financial viability of the organization. If any law, regulation or contractual obligation is enacted and/or changed subsequent to the effective date of the policy and that change would result in greater “Financial Assistance” to the “patient”, those provisions will be considered as part of the policy as of the effective date of that change. The policy shall provide “Financial Assistance” for emergency hospital services, including emergency transfers pursuant to the federal Emergency Medical Treatment and Active Labor Act (42 USC 1395dd), for patients who reside in New York State and for “medically necessary” services for patients in the “primary service area” of Brooks Memorial Hospital. “Patients” who do not meet these residency requirements can apply for “financial assistance” and the eligibility determination will be made on a case by case basis. The policy addresses only the facility charges for services rendered at Brooks Memorial Hospital by Brooks Memorial Hospital employees. The policy does NOT apply to any physician, independent individual or agency rendering services to the “Patient” in conjunction with the services provided, while a “Patient” at Brooks Memorial Hospital. The reduction or discounting of insurance co-payments and deductibles will be considered under this policy for those individuals who can demonstrate an inability to pay such amounts.  Brooks Memorial Hospital recognizes the request for “Financial Assistance” may be a sensitive and deeply personal issue. The confidentiality of information and preservation of individual dignity shall be maintained for all who seek “Financial Assistance”.