Financial assistance through the hospital's Charity Care Program, is available to patients who meet the requirements for emergency, medically necessary services under the terms and conditions the hospital offers to qualified patients. For more information please contact the Financial Counselor at 618-833-4511 ext. 4312 or 4266.
Click below for a Financial Application.
Application for Financial Assistance
Our hospital recognizes that there are occasions when patients are not able to meet their financial obligation for emergency, medically necessary services.
If you or members of your household are experiencing financial difficulty and are not covered by private or government sponsored health insurance programs, please contact our Financial Counselor who will assess eligibility for charity care.
Charity Care is meant to provide financial relief to patients who are low income, uninsured and medically indigent, who are in need of emergency, medically necessary hospital services. It provides full relief from financial liability to those patients whose income falls at or below the U.S. Department of Health and Human Services Poverty Guidelines or partial relief to those whose income is slightly above the Poverty Guidelines.
Contact our Financial Counselor at 618-833-4511 ext. 4312 or 4266 to discuss your financial situation.
Our goal is to work on an individual basis with each patient to fully explore all coverage options, including applying for assistance through publicly funded programs.
- All available financial resources (e.g. Illinois Medicaid) must be exhausted before consideration for charity. There are eligibility requirements for government funded programs. Full cooperation is expected.
- Application for assistance must be made within 60 days from date service was provided.
- Guarantor must contact the Financial Counselor who will conduct an interview to determine if applicant meets the program criteria
- If the applicant meets the program criteria, then the charity form must be completed, signed, and returned with supporting documentation which includes the following:
- most recent tax return
- last 3 months proof of income (e.g. employment check stubs, statement from employer, unemployment, social security, etc.)
- bank and investment statements