Financial Services

Applications are available at the Patient Access Services Department, Emergency Department, Patient Financial Services Department, or by clicking here to download and print a PDF version of the application. They must be filled out completely. All required verifications should accompany the application. Incomplete applications will be returned. Specific instructions to assist you with completing the application are included in each application packet.

Every effort will be made to process complete applications within 60 days of receipt. You'll be notified of the determination in writing.

Approved applications are valid for only the accounts and amounts outstanding at the time of approval. If you receive additional services at any later date, it will be necessary for you to complete a new application in order to have those accounts considered for the CFC program.

Each account is eligible for only one write-off. You may not reapply for any remaining balance(s) that are set up for repayment on a time payment plan.

If terms of the contract are not kept (i.e., monthly payments not made) and Bartlett Regional Hospital finds it necessary to pursue collections or legal action for any of the account(s) approved for CFC write-off, the amount(s) written off will be reversed and added back to the account(s).

Credit and collection office staff will be happy to answer any questions you may have about the program or the application process. Call 907.796.8827 between 8 a.m. - 4 p.m., Monday through Friday, except for legal holidays.

All types of services which the hospital provides with the exception of referred outpatient services and elective procedures (specifically sterilization, sterilization reversals and cosmetic surgery), unless indicated by the physician to be medically necessary, will be considered eligible for consideration.

You must be a resident of the state of Alaska to be eligible to apply for the CFC program.

We will accept applications only for the dates of service or insurance payment or denial that has occurred 90 days or less before the date of your CFC application is received by the hospital. (Extra days are allowed for mailing.) The discharge date from the hospital will be used for inpatient services.

For example: If you were a patient in the hospital from May 20 to May 23 and had no insurance, you would need to submit an application to the CFC program by Aug. 23 for that particular hospitalization to be considered. If you were in the hospital on those same dates, but had insurance and were applying to the CFC program for the balance remaining on your account after insurance paid, then you would need to submit your application 90 days after your insurance payment was received by the hospital. If your insurance was received on July 10, you would need to submit your application by Oct. 10 in order for that hospitalization to be considered.

Before an application is submitted and considered, all other possible resources, such as Medicare, Medicaid, other federal programs and other third-party payers, must be exhausted. If you appear to be eligible for any other assistance, you must submit a denial before your application can be considered.

If any other payment source would have been available but you did not comply with terms of that payer and payment was denied, the denied amount will not be eligible for CFC program coverage.

A deductible or co-insurance amount due on an account after payment by another payer is eligible for consideration, if all other criteria are met. This includes Medicare deductible and co-insurances.

Specific portions of claims denied by another payer because they are not covered will be eligible if you could not have been expected to know that the services were not going to be covered. If you were notified in advance that a specific service or portion of your hospitalization would not be covered by your insurance, then that portion of your account cannot be considered for the CFC program.

Financial determination is based on the assets and gross income of all persons in the household of the applicant. A household is identified as a single person at least 18 years of age or older, an emancipated minor 16 years of age or older, or a group of people who would be a family for tax purposes.

Asset limits will be considered first when determining eligibility. The CFC program will use an average of the asset limits that Medicaid uses when screening for their programs: $1500 for a single person, with $500 allowed for each additional dependent. Assets include savings and checking accounts, IRAs, KEOGH plans, and cash on hand. We will need verification of all these items. If you are over the asset limit for your household, your application will be denied, regardless of your income total.

Income guidelines are based on the U.S. Department of Health and Human Services poverty guidelines for Alaska. These are adjusted for family size and published annually. A sliding scale will be used to determine the actual amount of the account which will be written off. Click here to view Bartlett Regional Hospital’s 2022 Community Funded Care (CFC) income guidelines sliding scale.

All income must be verified. If you have stated you have no income, there will be an additional form to be completed and submitted with your application. It will also be necessary for you to get an unenmployment verification printout from Job Service. Permanent fund dividends, the Longevity Bonus, interest, dividends, alimony and child support, wages, self-employment earnings, retirement or pensions, social security, public assistance and disability or unemployment compensation all count as income.

As a condition of approval for the CFC program, you will be required to sign an agreement establishing a time payment plan for any remaining balances owed the hospital for any member of your household. Making regular payments as agreed will be a condition for future CFC program consideration.