The Fairview Range Charity Care program covers charges for most services. It does not cover charges for:
- Certain medical services (FAP Exclusions PDF)
- Care that is not needed (care not approved by a Fairview doctor or trial treatments)
- Care not offered at Fairview
- Services given at Fairview by independent providers (FAP Providers Excluded PDF)
- Retail services from pharmacies or hearing center, etc.
If you do not know whether the care you are seeking is covered, please ask us. If you have questions, call 218-362-6624 or (toll-free) 877-390-6624.
Can I apply for financial help for my hospital bill if I can’t pay the rest of my bill?
Yes. If your insurance has paid part of the bill but you need help in paying your balance, you can apply for Charity Care.
Why do I need to look for other funds before I receive financial help?
No single organization can meet the needs of all patients who are unable to pay. Patients who need financial help should use all resources for which they are qualify.
What factors determine the help I’ll receive?
Patients qualify for help based on income, assets and family size. If you qualify, you will get a 50-100 percent discount on medically necessary services. Charity Care Income & Asset Guidelines (PDF)
Who do I contact if I have more questions?
For more information about Fairview Range Charity Care program, please call Patient Financial Services at 218-362-6624 or (toll-free) 877-390-6624.
Thank you for your interest in Fairview Range’s Charity Care program. Please use the application to apply for this program. Not supplying the information requested or a reasonable substitute within 30 days may disqualify you for assistance.
To apply review the instructions below and complete our Charity Care Application Form (PDF).
Step 1: Complete and sign the application form.
- List the names and birth dates for each family member applying for the program. If you do not list them on the form, they will not be included.
- If married, both parties will need to sign the application.
- Your family size is the number of supported family members in your household. This should be the same as what you’ve listed on your tax return.
Step 2: Attach these items to your application. We will keep your records confidential. Please include records for all adults in your household.
- A copy of your most recent 1040 Federal Income Tax Form
- Records of income over the past three months. (Examples: Pay stubs, social security award letter, and unemployment stubs)
- Copies of current bank statements for all checking and savings accounts. Provide as much information as possible regarding your assets.
- Optional: a letter explaining any recent events that might affect your ability to pay your medical bills.
Step 3: Return the form with the above records to the following address:
Attn: Patient Financial Services
750 E 34th Street
Hibbing, MN 55746
Partial applications will not be accepted and returned to the applicant. At such time, collection on balances due will resume.
Step 4: If you have applied for Medical Assistance, you will receive a letter of approval or denial. Send a copy of the letter with this application.
Charity Care may help pay for Fairview Range bills with balances greater than $250.00. It is intended as a form of assistance in the time of financial need –it does not replace your insurance. To encourage patients to not look at Charity care as a means of insurance; eligibility will be once a year for 3 months. If you or your spouse has access to an affordable health plan, but you’ve chosen not to, you are not eligible for this program.
You will keep receiving bills until we have your completed application. You are responsible for balances in our office. Those accounts that have legal fees will not be eligible for Charity Care.
If you have any questions, or you can’t return the forms on time, please call me at (218) 362-6624.