Financial Info & Forms


Financial Information & Forms

At Adair County Health System (ACHS), we want you to understand the financial assistance programs available to you. You may call our Financial Counselor at 641-743-7266 to learn more.

If You Have Insurance ACHS will submit to your insurance company for payment. However, you are responsible to make sure your balance with ACHS is paid in full. It is also your responsibility to be aware of any exclusions, benefits, co-payments and deductibles outlined in your insurance plan. To ensure our records stay up to date, we will ask for your insurance card each time you are registered.

If you are unsure if we accept your insurance, please call our Revenue Cycle office at 641-743-2123 to verify with office staff.

Payment arrangements

If you do not qualify for Medicaid and/or Financial Assistance, you will be asked to make payment arrangements with the Financial Counselor at 641-743-7266. Your monthly payment will be based on the balance of your account. We do offer prompt pay discounts.

Senior Health Insurance Information Program

The Senior Health Insurance Information Program (SHIIP) program is a free, objective information service provided by volunteers trained by the Iowa Department of Insurance.

Volunteers assist patients, families and staff in understanding Medicare benefits, which includes:

  • Organizing medical bills, Medicare statements, and filing Medicare claims.
  • Providing information on long-term care insurance policies.
  • Comparing and evaluating Medicare supplement policies and drug plans.
  • Recognizing Medicare fraud and abuse.

For more information or to make an appointment, contact the SHIIP Counselor at 641-743-7266.

For Individuals Without Insurance

If you do not have insurance, our Financial Counselor can help you determine if you qualify for any of the following programs, including:

We can assist you in an application for Medicaid once we determine you meet the requirements for the program. You may also apply online
Financial Assistance is offered to all individuals served by ACHS

Eligibility is determined using the Federal Poverty Guidelines and is based on the number of members in the household and the annual income of the household.