# Hawkins County Memorial Hospital

Hospital in Rogersville, TN. Verified from the hospital's own policy.

Hawkins County Memorial Hospital likely gives free care to households with a yearly income up to $35,910 for 1 person, $48,690 for 2, $61,470 for 3, $74,250 for 4, $87,030 for 5 or $99,810 for 6. It likely gives a discount to households with a yearly income up to $71,820 for 1 person, $97,380 for 2, $122,940 for 3, $148,500 for 4, $174,060 for 5 or $199,620 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $35,910 | $71,820 |
| 2 | $48,690 | $97,380 |
| 3 | $61,470 | $122,940 |
| 4 | $74,250 | $148,500 |
| 5 | $87,030 | $174,060 |
| 6 | $99,810 | $199,620 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 225% of poverty level, patient pays nothing (100% financial assistance), unless assets over $25,000
- 225% to 450% of poverty level, patient pays partial discount on a sliding scale by income (exact percentages not published in the policy)

## How to apply

- Call (888) 288-5174 and ask for financial assistance.
- [Application form](https://www.balladhealth.org/sites/default/files/2026-01/Ballad-Application-Assistance-2025.pdf)
- [Financial Assistance Policy - Ballad Health (PFS-400-003-BH, effective April 29, 2025)](https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf)
- [Plain language summary](https://www.balladhealth.org/sites/default/files/2026-05/Plain-Language-Summary-Financial-Assistance-APPROVED-12-20-2023-WCAG.pdf)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring application for financial assistance, last two years of federal tax returns (or IRS form 4506-T if you did not file), W-2 and last 3 pay stubs, benefit letters (Social Security, disability, pension), if any, most recent checking, savings and health savings account statements, stocks, bonds, CDs and mutual fund statements, if any, most recent mortgage statement, if you own your home, food stamp approval letter, if any, Medicaid approval or denial letter.
- Savings and property. The policy counts savings or property, not only income.
- Languages. English, Spanish

## If you have insurance

Insured patients can also apply for help with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## What is covered

Covered. Emergency care and other medically necessary hospital care at Ballad Health hospitals and Ballad Health clinics.

Not covered. Elective procedures are covered only case by case. Outside doctors and other providers may bill separately and are not covered by a Ballad application. Ask for the Provider Participation List to see who is covered.

## Notes

One Ballad Health policy covers all of its Tennessee and Virginia hospitals. The policy lists Hawkins County Memorial Hospital by the short name HCMH. Free care counts household income and also savings, checking, stocks and bonds, and property other than your home. Assets over $25,000 can affect free care. Insured patients may also apply. Apply within 240 days of the first bill after you leave the hospital. You get 30 days after applying to send missing papers. Collection actions stop while a complete application is reviewed. If you are approved, payments made in the 240 days after the first bill can be refunded. Medicaid patients in some situations, and deceased patients with no estate, may get full help without the paperwork. Specialty pharmacy medicines use a separate process (call 1-888-952-3773). A denial can be appealed with the appeal form on the financial assistance page. Help line is (888) 288-5174, 8 a.m. to 4:30 p.m., Monday to Friday.

## Sources

- Free care level https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > FAP-Eligible Individuals having annual Household Income below 225% of the Federal Poverty Guidelines will be eligible for 100% financial assistance
- Discount level https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > Household Income between 225% and 450% of the Federal Poverty Guidelines
- Discount steps https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > may be eligible for a partial discount, based on a sliding scale of income, on AGB charges.
- Insured patients https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > FAP-Eligible Individual means an Uninsured, Underinsured or Insured Patient who may be eligible for financial assistance under this Policy
- Asset test https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > will be eligible for 100% financial assistance, unless their Asset Value exceeds $25,000.
- Deadline https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > apply for financial assistance up to two hundred forty (240) days from the date of the first post-discharge billing statement.
- Documents https://www.balladhealth.org/sites/default/files/2026-01/Ballad-Application-Assistance-2025.pdf
  > Last two years of Federal Tax Returns are required. If you did not file taxes, you must provide a 4506-T form from the IRS.
- Languages https://www.balladhealth.org/sites/default/files/2026-05/Plain-Language-Summary-Financial-Assistance-APPROVED-12-20-2023-WCAG.pdf
  > the Financial Assistance Application, and this Plain Language Summary are available in English and Spanish.
- Financial counseling phone https://www.balladhealth.org/sites/default/files/2026-01/Ballad-Application-Assistance-2025.pdf
  > call 888-288-5174 Monday – Friday, 8:00 a.m. to 4:30 p.m.
- What is not covered https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > This policy does not apply to elective procedures except on a case-by-case basis as may be determined in the sole discretion of Ballad Health.
- Covered facility https://www.balladhealth.org/sites/default/files/2026-05/Financial-Assistance-Policy-Ballad-Health-6-16-25-WCAG.pdf
  > Tennessee: BRMC, FWCH, GCH, HCH, HCMH, HVMC, IPCH, JCCH, JCMC, SSH, UCH, WPH

Last checked 2026-11-11.

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