MRI Uncompensated Care Program

What is it?

Patients who are unable to pay for medically necessary services because of low income or other financial difficulties will be considered for uncompensated care.  Assets, income, family size and total medical debts are used in determining the amount of uncompensated care.  Financial assistance may be provided for part or all of the patient’s balance based on the federal poverty guidelines, which are published annually by the U.S. Department of Health and Human Services.  Patients may be eligible for assistance in excess of what they would be granted under the income guideline criteria if they have incurred catastrophic medical costs that substantially reduce their ability to pay.  Turville Bay will review all applications without discrimination to ensure equal treatment regardless of age, race, religion, color, handicap, national origin, sex, or other prohibitive basis.

How do I apply?

Uncompensated care applications are available at the registration desk and from Turville Bay’s Billing Coordinators.  The application should be submitted prior to receiving services, if possible, or within 30 days of receiving services.  Applicants should explore all other means of payment such as insurance, medical assistance or the possibility of making a personal payment arrangement before applying for uncompensated care.   Applicants must provide documents supporting their income level, such as current income tax returns, paycheck stubs and outstanding medical bills, with the application.  Once it is completed and signed, the application should be returned to the attention of the Billing Coordinator at 1104 John Nolen Drive Madison, WI 53713.  Applicants will be notified by telephone or mail of the status of the application within 14 days of receipt, and may request an appeal if the application is denied.  Applications are in effect for one year, and patients may re-apply within that year if their financial situation changes substantially.

Turville Bay Uncompensated Care Application