Patient Financial Services submits claims to a patient's insurance and follows up until the claim is resolved. We also serve as a resource for patients, guarantors, insurance companies, etc. Individuals can call or come in to discuss billing issues, insurance payment issues and information, our financial assistance policy for hospital services, or our sliding fee program for physician services.
All applications for sliding fee and/or financial assistance should be sent to the following address:
Patient Financial Services
1001 E. Second St.
Coudersport, PA 16915
Physician office sliding fee information
Sliding Fee Allowance Limits (PDF)
Sliding Fee Application Form (PDF)
Financial Assistance Program
When applying for the financial assistance program for hospital-based services, the following requirements are needed to process your application: denial letter from Pennsylvania Medical Assistance, proof of income for the past six months; and pay stubs, bank statements, unemployment and social security statements or records, etc,. along with the completed financial assistance application.
Federal Poverty Guideline (PDF)
Financial Assistance Policy (PDF)
Financial Assistance Application (PDF)
Financial Assistance Income Guidelines (PDF)
Plain Language Summary (PDF)
Billing and Collections Policy (PDF)