To find out if you qualify for financial assistance, please click here to download and complete the application form and attach documents that prove income, assets, or other available resources, as detailed in the Financial Assistance Guideline Letter. If you need help completing the application, financial counselors can call 931-438-7482 Monday-Friday, between 8:00 AM and 4:30 PM. All inquiries are confidential.

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Financial Assistance Policy

Print and complete the application form and mail it to the financial counselors at the following address:

Lincoln Medical Center
Attention: Financial Counselor
106 Medical Center Blvd
Fayetteville, TN 37334

When completing the application form, be sure to include documents that verify your income and assets for yourself and for your spouse (if applicable). Examples of documentation to verify eligibility include pay stubs, tax return forms, and bank statements. Additional forms of verification may be required.

We will determine financial assistance eligibility based on income and asset guidelines and the Federal Poverty Income Guidelines. Approved applications apply to Huntsville Hospital Health System accounts only. Applicants will be notified by letter regarding their financial assistance application status.

If you are currently employed, please verify gross income for the last three months. Verification can be a current check stub with a year-to-date total or a letter from your employer on company letterhead.

If you are self-employed, please provide a complete copy of the prior tax year’s income tax return, including schedule C and all forms.

If you are unemployed and drawing unemployment benefits, please verify the amount you receive. Verification can be your unemployment benefit approval letter.

If you are unemployed and have no income, please verify your circumstances. Verification can be provided by a written statement from your physician, church pastor, or attorney.

If you are collecting Social Security, SSI, Social Security Disability, or Veteran or Military Pension, please verify income. Verification can be a copy of your most recent check stub or a letter from the government showing the amount you are receiving. If your minor children also receive a check, please verify their income.

If you are collecting a retirement check, pension, annuity, short/long-term disability, or workers’ compensation, please verify that income. Verification can be a copy of your most recent check stub or a letter from the income source.

If you receive Food Stamps, AFDC (Aid for Dependent Children), or FA (State-provided Family Assistance), please verify the assistance. Verification can be your approval letter outlining your proof of eligibility.

If you receive child support or alimony or assistance from your children’s other parent (not living in the household), please verify that income source. Verification can be a copy of your child support order or divorce decree.

Please provide legal proof of separation if you are separated or going through a divorce.

If your monthly expenses exceed your income, please verify how your monthly expenses are satisfied. Verification can be letters of financial support from your family, friends, church, or other organizations. If you are using credit cards, cash advances, or loans to satisfy your monthly expenses, please provide copies of the most recent statement of those items.

Please provide the most recent copy of your complete bank statement (including all pages of all checking, savings, or certificates of deposits). If your bank account has been closed, please provide a letter from the bank stating your account has been closed.

Other assets, such as real estate (other than your primary residence), rental income, or investment equity, will be verified during the financial application process.

Extraordinary collection actions will be suspended while considering a completed charity care application. Before placement with an agency, the patient’s account will be noted to suspend any collection activity while the account is under review. If the account has been placed at the agency, the agency will be notified by telephone to stop collection efforts until a determination is made. If a charity care determination allows for a percent reduction but leaves the patient with a self-pay balance, payment terms will be established based on disposable income.

If supporting documentation is not submitted with the financial statement or falsification of any portion of the application is identified, your application will be denied. We reserve the right to reverse financial assistance when information indicates the patient/guarantor can pay for services and financial assistance should not have been approved.

PLEASE NOTE: The financial assistance offered under this program does not apply to physician or other professional fees billed separately from the hospital fees. For questions or assistance with the financial assistance application, please call our financial services office at 931-438-7482. If paying without insurance, arrangements can be made with patient financial services.

A self-pay discount will be offered to uninsured patients who receive services payable to Lincoln Medical Center, Patrick Rehab, and EMS. Uninsured patients are those who do not have valid insurance coverage for medical services they receive. The Self-Pay discount is currently set at 46.4% of total billable charges. The discount is based on the THA computation of the maximum hospital collection rate from the uninsured in compliance with Tennessee Code 68-11-262, effective for the calendar year. This policy does not include employee pharmacy charges, employee supplies, contract drug screens, or instructional classes offered to employees or the community.