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Financial Assistance Plain Language Summary

Brook Lane is dedicated to providing patients with the highest quality of care and services. To assist our patients and to comply with Federal and Maryland State laws, we offer the following information about our Financial Assistance Policy (FAP).

Eligibility for Financial Assistance

Under the Brook Lane FAP, certain uninsured and underinsured patients may be eligible to receive financial assistance for the cost of emergency and medically necessary hospital services. Patients eligible for financial assistance under the FAP will not be charged more for emergency or medically necessary care than the amount generally billed to insured patients. Eligibility is based on gross family income and family size of the patient and/or responsible person. Annual income criteria used will be 250% of the current federal poverty guidelines as established yearly in Federal Register. Asset and liabilities will also be considered. Financial assistance may be awarded up to 100% of medical charges.

Applying for Financial Assistance

Patients seeking financial assistance must complete an application and provide the supporting documentation requested in the FAP and the application. A copy of the FAP and the application is available in person at any of the following locations:

Brook Lane Main Campus
13121 Brook Lane
Hagerstown, MD 21742

Brook Lane Frederick Outpatient
5301 Buckeytown Pike, Suite 170
Frederick, MD 21704

Brook Lane North Village Outpatient
18714 North Village
Hagerstown, MD 21742

Translations of the FAP, the application and this plain language summary are available in the following languages upon request: Spanish. If you have any questions or need help completing an application, you may schedule an appointment by calling 301-733-0330 or toll free 1-800-342-2992 and asking for Patient Accounts.

Patient Obligations

For those patients with the ability to pay, it is their obligation to pay in a timely manner. Brook Lane makes every effort to see that patient accounts are properly billed and inpatients may expect to receive a uniform summary statement within 30 days of discharge. It is the patient's responsibility to provide correct insurance information.

If you do not have health coverage, we expect you pay the bill in a timely manner. If you believe that you may be eligible under Brook Lane's FAP, or if you cannot afford to pay the bill in full, you should contact us as noted above.

If you fail to meet the financial obligations of your bill, you may be referred to a collection agency. It is the obligation of the patient or legal guardian to assure the hospital obtains accurate and complete information. If your financial position changes, you have an obligation to contact Brook Lane to provide updated information.