Patient Tools
Federal Form 990– For the year ended Dec. 31, 2020
Patient Guide
Click here to read our Patient Guide and learn about the services we provide, phone numbers to have handy during your hospital stay, and much more.
The No Surprises Act
Salem Medical Center (SMC) complies with the price transparency and out-of-network federal law for our patients. The new federal law that requires SMC to provide you with a better understanding of your possible out-of-network financial responsibility and protects you from “surprise billing”.
On January 1, 2022, the No Surprises Act (NSA) was created as part of the Consolidated Appropriations Act of 2021. This law was created to protect patients from unexpected bills. The law requires healthcare providers, SMC, to provide a good-faith cost estimate to uninsured/self-pay patients before services are rendered. The law also prohibits out-of-network providers and healthcare facilities from balance billing the difference between allowed charges and provider charges without notice and signed consent. The law also clearly outlines the complaint and dispute resolution processes.
In New Jersey the law also protects you from being billed for services at an in-network facility provided by out-of-network provider in an amount in excess of your in-network cost-sharing amount for example, the amount of your deductible, copayments or coinsurance would have been if the same services were provided on an in-network basis.
We are happy to assist, if you have any questions, please call 856-935-1000 and ask for our Patient Customer Service line.
Financial Assitance / Charity Care
Financial Assistance Policy – Plain Language Summary
Below find documents to apply for Salem Medical Center’s Charity Care program
English
- Affidavit of Separation
- Affidavit on behalf of patient
- Application for Participation
- Charity Care Required Document Checklist
- Patient / Responsible Party Certifications
- Spouse / Other Responsible Party Certifications
- Affidavit of Personal Recognition
- Affidavit of Unreported Income
Spanish
- Charity Care Application (Spanish)
- Declaracion de ingresos no reportados
- Declaracion de no contacto
- Declaracion de reconocimiento personal
- Declaracion de separacion
- Declaraciones en nombre del paciente
- Charity Care Required Document Checklist (Spanish)
Pricing Estimator
Click below to receive estimated prices of SMC procedures.