Susquehanna Health Medical Group (SHMG) has developed our Financial Assistance Program to reflect the Susquehanna Health Mission and Values. With proper application of this policy and procedure, patients in need of healthcare services can expect patient care from SHMG physicians with a financial responsibility that may be discounted or eliminated.

Susquehanna Health Medical Group will provide Financial Assistance for patients that require medically necessary services during the period in which family income and financial resources meets defined guidelines, and after all other payment resources have been exhausted.

The income guidelines source is the annual poverty income published in the Federal Register by the Department of Health and Human Services.

Eligible services include inpatient and outpatient services, which are medically necessary and are provided directly by SHMG providers for treatment of an illness or injury. Ineligible services are any charges associated with skilled nursing service, cosmetic surgery services, hearing aids, and infusion services.

STEP 1

PA Medical Assistance eligibility determination must be completed. Patients can apply for Medical Assistance by calling the Lycoming County Assistance Office at 1-877-867-4014 or 570-327-3300 or by visiting in person at 400 Little League Blvd Williamsport.

STEP 2

It is the patient’s responsibility to complete the SHMG Financial Assistance Application.

STEP 3

The completed application, approval or denial from Medical Assistance, and return verification of income from all sources. (Federal Income Tax return and / or Social Security Benefits statement from the year(s) prior to your open balances). You must send copies of your entire income tax return, including all related schedules and copies of all income support within the household. (W2’s, Form 1099, etc.). Submit all information to:

Susquehanna Health Medical Group Call Center
PO BOX 3127
Williamsport, PA 17701

If you have any questions about the SHMG Charity Care Program, please feel free to visit us in person at 1201 Grampian Blvd – Suite 1K - Williamsport, PA 17701 or you may call us at 1-800-223-3479 or 570-326-8723.