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Financial Assistance

 
Financial-Assistance3Covenant Health is committed to providing quality health services in a caring environment. It is the expressed philosophy of Covenant Health, and its member hospitals, that no one should be denied necessary medical care because of the inability to pay. In conjunction with this philosophy, staffs of Cumberland Medical Center are available to assist you with your financial needs.

If you are an uninsured person with no public or private source of payment for medical services, Cumberland Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling (931) 484-9511 or (931) 459-7281, Monday through Friday between the hours of 8:00 a.m. and 4:30 p.m.
 
 
Criteria Categories for Financial Assistance
  • Before any financial assistance is granted, you must have already exhausted all other sources of payment including insurance, public assistance, litigation, or third-party liability.

  • Family income, in relation to federal poverty guidelines

  • Assets (e.g. home, bank account, and stocks)

  • Any additional financial hardship

  • You must be receiving non-elective, medically necessary care, and you must live within the service area of Cumberland Medical Center.


How to Apply for Financial Assistance

  1. Call financial counseling services at (931) 459-7281. A financial counselor will advise you and investigate other sources that might provide financial assistance.

  2. Complete a financial assistance application and submit it along with the following.

  3. Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year's W-2 forms.

  4. Copies of the three most recent, paycheck stubs or a statement from the employer.

  5. Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)

  6. Copies of unemployment, disability compensation benefits statements

  7. Copies of social security or pension benefits income

  8. Copy of food stamp allocation

  9. Copies of government assistance notices (including Department of Health & Human Services)

  10. Copy of TennCare denial letter

Note: If you do not have all of these documents contact one of our financial counselors. All correspondence to the financial counselors should be marked "Attention Financial Counseling".


How to Obtain a Financial Assistance Application

There are several ways by which you can obtain an application for financial assistance.

  1. Print the application off our Web site.

    The financial assistance application has been converted to Portable Document Format (PDF). To view the PDF file, you will need Adobe Acrobat Reader installed on your computer. If you do not have Adobe Reader cick the icon below and download a free copy.

    Click Here to Download Adobe Reader

    Click Here to Download the Financial Assistance Application

  2. Pick-up an application at any of the following locations:

    Patient Access Outpatient Imaging Center
    Patient Access First Floor CMC
    Patient Access at CMC Fairfield Glade
    Business Office Third Floor CMC facing Hwy 70

  3. Contact us by calling (931) 459-7281 to request an application.

 

Cumberland Medical Center will not discriminate in the determination of financial assistance eligibility on the basis of race, color, ethnic origin, sexual orientation, marital status, creed, age, sex or disability.

 

Contact Phone Number: (931) 459-7281

 
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How to Obtain a Financial Assistance Application
 
There are several ways to obtain an application for financial assistance.
 
1. Print the application from our Web site.
 
                    CLICK HERE
 
You will need Adobe Reader to view the application. If you do not have Adobe Reader on your computer download a free copy by clicking the icon below:
 
         icon get adobe
 
2. Pick-up an application at any of the following locations:
 
-Patient Access Outpatient Imaging Center
-Patient Access 1st Floor of the Hospital
-CMC Patient Access at CMC Fairfield Glade
-Hospital Business Office
 
3. Contact Us

To request an application call: (931) 459-7281