Upper Connecticut Valley Hospital

181 Corliss Lane Road
Colebrook, NH 03576


P: (603) 237-4971

F: (603) 237-4452

W: ucvh.org

Financial Assistance and Billing

Upper Connecticut Valley Hospital (UCVH) provides eligible patients fully discounted emergency or medically necessary care through UCV Free Care.Certain exclusions apply, including, for example, elective services, balances covered by other funding sources, and failure to cooperate in securing alternative funding sources (including Medicaid, Medicare, Insurance exchange and Employer sponsored insurance).This document is only a summary.Please click here to review our Plain Language Summary or Financial Assistance Policy for complete details.

Assistance Offered and Eligibility

Patients who qualify for assistance receive 100% coverage through UCV Free Care for emergency and other medically necessary services. The necessity for medical treatment of any patient will be based on the clinical judgment of the health care provider without regard to the financial status of the patient.All patients will be treated for emergency medical conditions regardless of ability to pay or to qualify for financial assistance in accordance with federal and state law.

To be eligible for Financial Assistance, patients must qualify based on income and assets as follows:

  • Household annual income (including defined assets) does not exceed 300% of the Federal Poverty guidelines, based upon family size.
  • Assets (not including up to $250,000 for primary residence and up to $250,000 in retirement accounts) will total less than $5,000 for an individual, $10,000 for a family.

Patients without insurance, and not eligible for UCV Free Care, will not be charged more than the amounts generally billed to patients who have insurance.

Applying for Financial Assistance

The application process involves filling out the Financial Assistance Application and submitting the application and supporting documents for processing.

To expedite services, please print our Financial Application. If you need assistance completing your application you can schedule an appointment with our Patient Financial Coordinator by calling (603) 388-4234.

Once complete, you may drop off the application or send it in the mail to Patient Financial Services, 181 Corliss Lane, Colebrook, NH 03576. You can fax your application to 603-388-4171. You may also scan your completed document and return it electronically to Chelsea Brooks: This email address is being protected from spambots. You need JavaScript enabled to view it. This email address is being protected from spambots. You need JavaScript enabled to view it.

PRICING

The following is a list of some common services/procedures performed at Upper Connecticut Valley Hospital. It is important to note that these are price estimates. There may be additional related procedures, tests, treatments or supplies may be provided and billed separately.

Hospital Chargemaster

The information provided is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital, also known as a chargemaster, which Upper Connecticut Valley Hospital posts on an annual basis.

PLEASE NOTE: Standard charges shown in the chargemaster do not necessarily reflect what a patient ultimately pays for services and therefore may not be a helpful tool to estimate their out of pocket responsibility or to compare hospital costs.

Services rendered may include professional as well as facility charges, which will be listed separately in the chargemaster.

Because of the complexity of hospital billing, and because chargemaster rates are updated periodically, patients should contact our patient financial services staff at 603-388-4234 for information about the cost of your care.

For more information regarding Price Transparency & Healthcare Pricing click below:

Price Transparency

2019 Financial / HFMA Consumer Guide to Healthcare Pricing

BILLING

Upper Connecticut Valley Hospital partners with North Country Healthcare to provide patient billing services through a centralized business office. For information regarding your bill, please call 877-642-4122 and speak to one of our representatives.

There are services offered at Upper Connecticut Valley Hospital that may cause you to incur charges from other billing companies as they services are provided by non-participating providers.Please click here to view a list Participating Provider and Non-Participating Providers.

181 Corliss Lane, Colebrook, New Hampshire 03576 (603) 237-4971
© 2018 Upper Connecticut Valley Hospital. All Rights Reserved

Upper Connecticut Valley Hospital provides communication assistance free of charge.
We have access to Language Interpretation, Video Sign Language, and many assistive devices for hearing and vision impairments, in order to accommodate your communication needs.
LANGUAGE ASSISTANCE