Financial Assistance/Charity Care

Haga click aquí para seguir en español

Financial Assistance
Adventist Midwest Health has developed a financial assistance program that provides a fair and clearly understood program of discounts for patients who are in need. The program emphasizes a hospital-patient partnership. This partnership approach helps our hospitals determine the best method of financial assistance for those in need.

Charity Care
If your annual household income is at or below 200 percent of the Federal Poverty Level (about $42,400 annual income for a family of four), you may qualify to receive services at no charge. A Financial Assistance Application Form must be completed and evaluated by our financial counselors prior to any discount being applied to your hospital bill. Proof of income may be required (Note: The Federal Poverty Level is set and updated annually by the U.S. Department of Health and Human Services).

Discounts
If you do not qualify for free care but need assistance with your hospital bill, you may qualify for a discount. Discounts are available for patients whose annual income is at or below 400 percent of the Federal Poverty Level (about $84,800 annual income for a family of four). To determine your eligibility, a Financial Assistance Application Form must be completed and evaluated prior to any discount being applied to your hospital bill. Proof of income may be required.

Collection Practices
Adventist Midwest Health's collection practices are based upon a partnership between the hospital and patient.

To Apply
Fill out the Financial Assistance Application Form and send it to the address in the upper right hand corner of the application. 

Click here for the English Financial Assistance Application Form

Haga click aquí para seguir en español.  Completar un Formulario de Solicitud de Asistencia Financiera en Español.