KCMH Financial Assistance

If you would like to apply for financial assistance, please complete the form below. Once completed, contact Kiowa County Memorial Hospital business office (620) 723-3341, or by email at [email protected]

2024 Financial Asst App (PDF)
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2024 Financial Asst App-Spanish (PDF)
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2024 Financial Asst Plain Language Summary- Spanish (PDF)
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2024 Financial Asst Plain Language Summary (PDF)
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APPENDIX A (PDF)
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APPENDIX A-Spanish (PDF)
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APPENDIX B 2024 (PDF)
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APPENDIX B 2024-Spanish (PDF)
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APPENDIX C 2024 (PDF)
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APPENDIX C 2024-Spanish (PDF)
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BUS.007 financial asst policy (PDF)
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BUS.007 financial asst policy-Spanish (PDF)
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BUS.008 Billing and Collection Policy -Spanish (PDF)
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BUS.008 Billing and Collection Policy (PDF)
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Payment Options

Partnership with PayZen

Kiowa County Memorial Hospital is pleased to announce that we have partnered with PayZen

PayZen offers affordable payment options, so you can now pay your bill over time with no interest or fees. Enrollment is fast, easy, and automated, with customized payment plans that work for your budget.

If you have an outstanding balance greater than $250 and would like to enroll in a payment plan, sign up at kcmh.payzen.com