Coffeyville Regional Medical Center (CRMC) is committed to providing services without charge or at reduced charges to those who qualify. Uninsured and underinsured individuals living within Montgomery County, Kansas, or within 50 miles of CRMC are eligible to apply for financial assistance under the provisions described herein. All patients, regardless of race, creed, sex, age, national origin, or financial status, may apply for financial assistance at CRMC.
If you do not have any health insurance, our Financial Advisors are available to assist you. These professionals will determine if you are eligible to apply for medical assistance (Medicaid) and will help you through the process. They will also help you apply for our Financial Assistance Programs, where part or all of your medical bills at CRMC may be reduced or forgiven.
You may print at no charge, CRMC’s Financial Assistance Policy and Financial Assistance at the following location:
Download Financial Assistance Application
View Full Financial Assistance Policy Here
A free copy of CRMC’s Financial Assistance Policy and Financial Assistance Application Form may be requested by calling 620-252-1549 or visiting one of our Financial Advisors located in the Admissions Department of the hospital at 1400 West 4th, Coffeyville, Kansas.
If you require CRMC’s Financial Assistance Policy and Financial Assistance Application Form Spanish, please contact one of our Financial Advisors located in the Admissions Department of the hospital by calling 620-252-1549 or visiting our Admissions Department of the hospital at 1400 West 4th, Coffeyville, Kansas.
To apply for financial assistance, complete the Financial Assistance Form and return to:
Coffeyville Regional Medical Center
1400 W. 4th
Coffeyville, KS 67337
To qualify for financial assistance, the following requirements must be met:
- Non-eligibility or denial of an application for medical assistance
- Completion of Financial Assistance Program application with supporting documentation
- Family size and household income at or below the Federal Income Poverty Guidelines
- Must be a U.S. citizen or have the appropriate residency from the United States Department of Justice
Patients eligible for financial assistance will not be charged individually more than Amounts Generally Billed (AGB) for emergency and other medically necessary care and not more than gross charges for all other medical care. CRMC will calculate the AGB percentage using the “look-back” method and include Medicare fee-for-service and all private health insurers that pay claims to CRMC, in accordance with 501(r). You can obtain this percentage amount by contacting the Financial Advisor at 620-252-1549.
Our Financial Advisors are available for confidential consultations regarding eligibility for this and other payment programs available. The Financial Advisors are located in the Admissions Department of CRMC and can be reached by calling 620-252-1549.