Patient Financial Assistance Information for Patients/Families
Financial Assistance Application
See the Financial Assistance section below to download the application and for instructions on how to apply.
Mt. Washington Pediatric Hospital has a Patient Financial Assistance program to help families with the costs of their child’s medical care.
When you schedule care here for your child, our authorization or admissions staff will help determine how much of the cost is covered by insurance, and how much of the cost will be your responsibility. (We do this as a courtesy - it is each family’s responsibility to understand their own coverage and benefits.) It is your responsibility to provide us with correct and complete information about your health insurance. If your coverage changes, it is your responsibility to promptly provide us with the new information. Physician services are billed separately but are discussed as part of the total estimated cost.
Unless other arrangements are made in advance, we require that 1/2 of any estimated self-pay balance be paid on the first day of care, and that the rest be paid weekly over the course of treatment.
If you are concerned about paying the self-pay portion of your child's care, you have the right to apply to Mt. Washington for patient financial assistance. We provide full assistance to families at or below 200% of the federal poverty guidelines; partial assistance to families with incomes up to 300% of the federal poverty guidelines; and assistance on a case-by-case basis to families with incomes above the 300% level.
You may be eligible for one or both of these programs:
- Payment Plan
Payment plans require that you pay the full self-pay balance, but allow you to pay over a longer period of time.
- Patient Financial Assistance
Patient financial assistance can reduce the amount of money that you pay for your child’s care. To apply for patient financial assistance, you will be asked to provide information about your family’s income and assets. You may also be asked for other information, such as pay stubs or tax returns. Assistance can provide free or reduced-cost care.
For questions regarding these programs, or an application for financial assistance, call:
- Mary Miller, Vice President of Finance, at 410-578-5163
- Linda Ryder, Manager of Patient Accounting, at 410-578-5206
- Denise Pudinski, Director of Collaborative Care at 410-578-2669 (inpatient only).
For any questions regarding hospital bills or payment, call the Patient Accounting office at 410-578-2614. To apply for health care coverage under the Maryland Health Care Connection, visit www.marylandhealthconnection.gov or call 1-855-642-8572; TTY 1-855-642-8573
Financial Assistance Application (PDF)
Please include the following items, and return to the address below.
- Two most recent pay stubs
- Most recent statements from any/all bank accounts
Note: Information should be submitted from each custodial parent/guardian.
Return form to:
Mt. Washington Pediatric Hospital
1708 W. Rogers Avenue
Baltimore, Maryland 21209
Att: V.P. Finance
This page was last updated: March 23, 2015