Billing and Financial Assistance

Saline Memorial Hospital is the local health care leader that provides quality services for our customers to enhance health and quality of life. In accordance with this mission, SMH will provide medically necessary health care to all patients without regard to the patient’s financial ability to pay. For all who seek charitable services, confidentiality will be maintained out of respect for our patients and their integrity.

The Saline Memorial Hospital Financial Assistance Policy exists to provide free or discounted care to eligible patients receiving medically necessary or emergent care. The full policy is summarized herein.

Eligible Services – Medically necessary and/or emergent healthcare services provided and billed by Saline Memorial Hospital and Saline Physician Services are eligible for financial assistance. Other services which are separately billed by other providers, such as physicians or laboratories, are not eligible for financial assistance under this policy. Elective cosmetic procedures are also not eligible for financial assistance under this policy.

Eligible Patients – Patients receiving eligible services, who submit a complete application for financial assistance form and are approved by Saline Memorial Hospital. Patients may also become eligible for financial assistance based on medical indigence, medical hardship, or presumptive eligibility. These additional eligibility methods are documented in the full Financial Assistance/Charity Policy.

How to Apply – Application for financial assistance forms will be given to all uninsured patients and to anyone else upon request at time of admission. They may also be obtained at any point during the patient’s visit or during the billing process by contacting a Patient Financial Services representative at 501-776-6069. Completed forms and supporting documentation can be submitted in person to any member of the Patient Financial Services Department or mailed to:
Saline Memorial Hospital
Attn: Financial Counselor
1 Medical Park Drive
Benton, AR 72015

Or you can apply online by clicking here: 

Determination of Financial Assistance Eligibility – Eligibility for financial assistance will be determined by using the United States Department of Health and Human Services Federal Poverty Levels (FPL) published at http://aspe.hhs.gov. Free care will be extended to applicants whose annual household income is less than or equal to 120% of FPL. Discounted care is based on a sliding scale to eligible applicants whose annual household income falls between 120% and 400% of FPL.

Note: Other criteria beyond annual household income is also considered including availability of cash or other liquid assets. If no household income is reported, information will be required as to how daily needs are met.

For help or questions please call one of our Patient Financial Service representatives at 501-776-6069.

To view the full Financial Assistance Policy, click here

To download the printable application, click here


Click here to pay your bill online. 

If you were involved in a motor vehicle accident, please click here to complete a motor vehicle accident form:

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