Financial Services
Our Commitment to Affordable Care
Memorial understands that it can be difficult for some patients to afford to pay their medical bills. For this reason, Memorial Health System of Southwest Oklahoma provides financial assistance for qualifying patients who receive emergency or other medically necessary care from Memorial. This summary provides a brief overview of Memorial’s Financial Assistance Policy.
Who is eligible for financial assistance?
Financial assistance is generally determined by your total household income as compared to the Federal Poverty Level. Patients with family incomes less than or equal to 150% of the Federal Poverty Level are eligible for a 100% charity care write-off of the portion of the charges for which you are responsible. Patients with family incomes ranging from 151% to 300% of the Federal Poverty Level are eligible for discounted rates on a sliding scale. To qualify for financial assistance, patients must complete a financial assistance application, provide requested documents to verify financial need, and meet other eligibility criteria. You may be asked if you have insurance of any kind to help pay for care. You may be asked to show that insurance or a government program will not pay for care.
How can I get more information?
Copies of the Financial Assistance Policy and application form are available from the Memorial Patient Access Financial Services, located in the Outpatient Center, 3401 W Gore Blvd, Lawton, OK 73505. Free copies of the Financial Assistance Policy and application also can be obtained by mail by calling Memorial Patient Access Financial Services at 580.699.7361.
How can I get help with my application?
For help with a Financial Assistance Policy application, you may contact:
Memorial Patient Access Financial Services
3401 W. Gore Blvd
Lawton, OK 73505
Free copies of the Financial Assistance Policy and application can be obtained by mail or by calling Memorial Patient Access Financial Services at 580.699.7361.
After the application has been reviewed, a determination of eligibility or non-eligibility will be made and you will be notified of the decision.
Which services are excluded from financial assistance?
The financial assistance is not available to services provided by providers who are not employed by Memorial or other providers who treat you at a Memorial facility, but bill separately from Memorial for their services and do not participate in the Memorial Assistance Program.
How can I apply?
You must apply for financial assistance by completing a written application and providing requested supporting documentation, as described in the Financial Assistance Policy and the Financial Assistance Policy application. The Financial Assistance Policy application instructions will be made available upon patient request at the time of service.
If a patient wishes to apply for financial assistance after the medical services have been provided, the Financial Assistance Policy application instructions may be accessed and printed directly from the Memorial website.
Patients may also request a copy of the Financial Assistance Policy application instructions by mail. To request a copy of the documents by mail, patients should call Memorial Patient Access Financial Services at 580.699.7361
What if I am not eligible?
If you do not qualify for financial assistance under the Financial Assistance Policy, you may qualify for other types of assistance. For more information, please contact Memorial Patient Access Financial Services, 3401 W. Gore Blvd, Lawton, OK 73505 or by telephone at 580.699.7361.
Downloadable Financial Assistance Forms
Please use the buttons below to access a downloadable file in .PDF format. Hard copies of the Memorial Financial Assistance Policy and application are available at Patient Access Financial Services, 3401 W Gore Blvd, Lawton, OK 73502 and can also be obtained by mail by calling Patient Access Financial Services at 580.699.7361.
Contact Us
Phone
Address
PO Box 129
3401 W Gore Blvd
Lawton, OK 73502