Patient Resources
West Holt Medical Services is proud to offer the following resources to our patients and their families.
Language Assistance
West Holt Medical Services will take reasonable steps to ensure that persons with Limited English Proficiency (LEP) have meaningful access and an equal opportunity to participate in our services, activities, programs, and other benefits. West Holt Medical Services utilizes Stratus Language Interpreting service that is available to patients free of charge to assist with communication during your visit.
Patient Rights & Privacy
West Holt Medical Services is required by law to maintain the privacy of your medical information and to provide you with notice of our privacy practices and your rights as a patient.
Medical Records
Authorization for Release of Health Information Form - English
Authorization for Release of Health Information Form - Spanish
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. Click here to learn more about the No Surprises Act and what it means for patients.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Helpdesk at 1-800-985-3059.
Financial Assistance
Consistent with its commitment to deliver compassionate, high quality, affordable health care services, West Holt Medical Services strives to ensure that the financial capacity of individuals needing health care services does not prevent them from seeking or receiving care.
West Holt Medical Services (incl. West Holt Medical Clinic) serves all patient regardless of ability to pay. Discounts for essential services are offered ona a Sliding Fee Schedule based on family size and income using the Federal Porperty Guidelines.
The following documents and links outline West Holt Medical Services’ charity care, collection policy, financial assistance and standard charges.
Sliding Fee/Charity Care Policy
Charity Care Application
Nebraska Medicaid Application
Federal Poverty Guideline
Collection Policy
Financial Assistance Policy - Plain Language Summary
Financial Assistance Policy
Comprehensive Machine Readable List of Standard Charges for All Items and Services UPDATED 10/13/2023
Blue Cross Blue Shield Machine Readable Files
MyLoans Payment Plan
Advance Directives
An Advance Directive is a written statement of your choices for medical treatment. You may name someone to make choices for you in the event you are unable to make your own decisions. An Advance Directive only goes into effect when you cannot voice your wishes.
The two main types of advance directives are:
Living Will: A legal document in which you specify what actions should be taken for your health if you are no longer able to make your own decisions.
Healthcare Power of Attorney: In a Power of Attorney (POA) document, you name another person to act as your “attorney-in-fact” or your “representative.” This person will make decisions for you if you become unable to make them for yourself. Your POA cannot be a member of your healthcare team unless he or she is a family member.
Patients admitted to West Holt Memorial Hospital will receive information designed to help them understand their choices in advance directives. You may wish to discuss these matters with your family, close friends, clergy, doctors and attorneys before deciding your preference.
If you wish to complete an advance directive, West Holt Medical Services can assist you at no charge. Contact our Social Worker Nikki Cook at (402) 925-1966 for assistance.
Nebraska State Immunization Registry
Families and individuals may use the Nebraska State Immunization Registry to view and print their immunization records.
Senior Resources
Patients and Family Members might be interested in learning more about assisted living in Nebraska. Utilize the Nebraska Assistated Living Guide here.
