Financial Assistance Policy

Willapa Harbor Hospital has a Financial Assistance Policy. This policy contains the guidelines for people to follow if they need any assistance with payment of their hospital bills. This policy applies to those who do not have insurance AND those who have insurance, and is based on income levels.

Please ask at the Admitting area or the Business Office for a copy of the guidelines and an application. Completed applications should be sent or delivered to the Business Office.

Hospitals which are nonprofit and recognized as 501(c)(3) organizations (including Willapa Harbor Hospital) shall limit amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under this Financial Assistance Policy to not more than the amounts generally billed to individuals who have insurance covering such care and may not collect “gross charges” from such individuals. See requirements WAC 246-453-040 and WAC 246-453-050 and IRS 501(r).

This financial assistance update is effective for dates of service beginning January 1, 2016. Elective services are not covered under our Financial Assistance Policy or the 501(r) requirements.

Our Financial Assistance/Uncompensated Care Program is based on a sliding fee schedule extending up to 250% of the federal poverty level.

In order to qualify you need to do three things:

  1. Complete the Financial Assistance application
  2. Provide information about your family’s gross income (income before tax deductions)
  3. Sign and date application

After all the criteria have been met, a determination will be made based on the income information.

Contact Us for Financial Assistance

Willapa Harbor Hospital wants you to understand your hospital bill. If you have any questions please call (360) 875-5526 and ask for the Patient Accounts Office. A Spanish translator is available.

A free copy of our Financial Assistance Policy is available at:

800 Alder Street

South Bend, WA 98586


Monday – Friday: 8 a.m. – 4:30 p.m.

You may also send a written request for a free copy of our financial assistance policy to:

P.O. Box 438

South Bend, WA 98586

pdfElectronic copies are available for download:

Financial Assistance Policy and Procedure:

English | Español 

Financial Assistance Plain Language Summary and Application:

English | Español 

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