Business Office - Molokai General Hospital

Office Hours:

8:00am till 4:30pm

Monday – Friday

Closed on Most Major Holidays

Contact Info:

Phone (808) 553-3127

Fax (808) 553-3133


What is this bill for? Attached to your first bill is an itemized statement that includes the date of your visit, your Patient Number, the treating physician, the amount you were charged, and the amount your insurance has paid. If you have any questions regarding your bill, please contact our Business Office and a staff member will be happy to assist you. What number should I reference when paying my bill? Your patient number. Can I pay with my credit card? Yes. Payments can be be made in person at the Business Office. You can also provide your credit card information over the phone and we will mail your receipt. Can I get a printout for my taxes? Yes. Please call us ahead of time so we can get it ready for you to pick up. If you prefer, a printout can also be mailed to you.


CHARITY CARE POLICY

OVERVIEW: The Queen’s Health Systems Hospitals (The Queen’s Medical Center at Punchbowl and West Oahu, Molokai General Hospital and North Hawaii Community Hospital) are committed to providing medical services to patients and objectively considers each patient’s
financial ability to pay for the cost of hospital services. Financial Assistance Policy (Charity Care)

The Financial Assistance Policy, also known as Charity Care, offers emergency and other medical necessary services at low or no cost to the patient. A discounted rate is applied to an eligible patient who does not have or cannot obtain adequate financial
resources to pay for their medical care. Our staff will assist individuals, free of charge, in applying for eligible governmental health insurance programs, such as Medicare and Medicaid/ Quest. Upon approval of the Financial assistance application,
individuals will receive a 100% or 65% discount. Applicants may be screened for Medicaid eligibility and requested to cooperate with applying for Medicaid-Quest.

Eligibility Requirements Financial assistance is generally determined by a sliding scale of total household income based on Federal Poverty Guidelines for US citizens and US residents or based on country minimum wage annualized for non-US citizens and non-US residents.

 

How and Where to Obtain Information and Assistance Regarding Our Financial Assistance Policy Please visit the Patient Access or Business Services offices at any of our hospitals where a representative will provide you with an application upon request. You may also contact a Patient Account Representative at (808) 691-5300, Monday through Friday from 8:00 a.m. to 4:30 p.m. at each hospital (addresses listed at the bottom of this sheet).

Applications are available at each hospital You may obtain a copy of the Financial Assistance Policy, financial assistance application and this plain language summary at each of the hospital’s websites: The Queen’s Medical Center The Queen’s Medical Center – West Oahu North Hawaii Community Hospital


Charity Care Policy:

Download

Exhibit B – Income Asset Qualifiers and Discount Rates:

Download

Exhibit C – Financial Assistance Application:

Download


Availability of Translations

Financial Assistance Application and Plain Language Summary are available in Japanese, Samoan, Vietnamese, Korean, Chinese, Tongan, Chuukese, Tagalog and Ilokano.

Japanese:

慈善医療ポリシーPlain Language Summary(概要説明書) – 付属書D
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クイーンズ・ヘルスシステム システムワイド管理ポリシー&手順
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資金助成申請書
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Samoan:

Aiaiga mo Fesoasoani Maua Fua Aotelega o Gagana – Exhibit D
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Polokalame fa’a le ‘au’aunaga mo le lautele ma fa’atinoga mole’āu’aunaga fa’a le falema’i.
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Talosaga mo Fesoasoani Tau Tupe.
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Vietnamese:

Chính Sách Chăm Sóc Từ Thiện Tóm Tắt Bằng Ngôn Ngữ Đơn Giản – Phụ Lục D
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Chính Sách và Thủ Tục Hành Chính Toàn Hệ Thống của Hệ Thống Y Tế The Queen
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Đơn Xin Hỗ Trợ Tài Chính
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Korean:

자선 진료 정책 쉬운 언어 요약본 – Exhibit D
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Queen’s Health Systems의 시스템 전반의 행정 정책 및 절차
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재정 지원 신청서
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Chinese:

慈善医疗政策简明语言摘要 – 附件D
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皇后健康系统的全系统范围的管理政策和程序
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经济援助申请
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Tongan:

Polisī ki he Tokoni ‘Ofá Fakamatala nounou ‘i he Lea Mahino – Fakamatala D
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Ngaahi Polisī mo e Founga Ngāue Fakakātoa ‘a e Queen’s Health Systems
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Kole Tokoni Fakapa’anga
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Chuukese:

Charity Care Policy Mesenapen Poraus Non Foosun Fonuom (“Plain Language Summary”) – Taropwe D
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Annuk me Otoot fan “System-Wide” non tettenin ewe Queen’s Health Systems
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Application ren Aninisin Monien Niwinum non Pioing (“Financial Assistance Application”)
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Tagalog:

Patakaran sa Kawang-gawang Pangangalaga Buod sa Simpleng Lengguwahe – Exhibit D
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Mga Pambuong Sistemang Administratibong Patakaran at Proseso ng The Queen’s Health Systems
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Aplikasyon para sa Pinansiyal na Tulong
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Ilokano:

Pagannurotan iti Tulong a Pannaripato Pakabuklan iti Simple a Pagsasao – Exhibit D
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Administratibo a Pagannurotan ken Wagwagas iti Intero a Sistema ti The Queen’s Health Systems
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Aplikasion para iti Pinansial a Tulong
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Please return your completed application to the attention of Business Services at:

The Queen’s Medical Center Punchbowl, 1301 Punchbowl Street, Honolulu, Hawaii 96813

The Queen’s Medical Center West Oahu, 91-2141 Fort Weaver Road, Ewa Beach, Hawaii 96706

Molokai General Hospital, 280 Home Olu Place, Kaunakakai, Hawaii 96748

North Hawaii Community Hospital, 67-1125 Mamalahoa Highway, Waimea, Hawaii 96743