Healthcare Assistance Program
Southern Illinois Healthcare is dedicated to improving the health and well-being of all of the people in the communities we serve. We understand that patients with limited financial resources have an obligation and willingness to pay but not always the ability. Consistent with Southern Illinois Healthcare’s values of compassion and stewardship, it is our privilege to offer Healthcare Assistance to qualifying patients.
A key provision of our Healthcare Assistance Program requires the cooperation of the patient in providing health insurance information, applying for available government programs and/or completing a Healthcare Assistance Application. All requests for assistance will be handled in a compassionate and confidential manner.
Southern Illinois Healthcare patients are encouraged to communicate with their hospital’s Financial Counselor if they anticipate difficulty paying their portion of the hospital services.
How to Apply
All sources of payment must be exhausted before financial assistance is considered. Examples of payments would be all medical insurance, third party/liability claims and Department of Public Aid.
To process a request for assistance, please submit following information:
- A completed Healthcare Assistance Program application signed and dated.
- A copy of your last federal tax return filed.
- If self employed you must include Schedule C.
- Please include a copy of all W2′s.
- A copy of your most recent check or check stub for employment, unemployment, Social Security, pension, workmen’s compensation (or work comp determination letter) or any other sources of income you have received for the past 13 weeks. We will accept one the following three documents for proof of wages:
- An employee wage form filled out and signed by your employers for each wage earner in the household. (see application for this form).
- Copies of check stubs for the last 13 weeks.
- A print out of your wages from your employer for the last 13 weeks.
- If applicable, proof of participation in Governmental assistance programs such as:
- SNAP (Supplemental Nutrition Assistance Program)
- WIC (Women, Infants and Children)
- Child Care Resource
- Referral Programs
Completed applications may be mailed directly to a Financial Counselor or emailed to email@example.com.
Only one application is required if you have accounts at any of our three hospitals. Income guidelines for eligibility are adjusted annually based on the Federal Poverty Guidelines established by the United States Department of Health and Human Services and published in the Federal Register. Healthcare Assistance Applications are available in English, Spanish and Arabic. To obtain a copy, contact a Financial Counselor at any SIH hospital.
Completion of this application does not relieve you of your financial obligation. Southern Illinois Healthcare provides assistance on a sliding scale up to 100 percent of hospital services. SIH reserves the right to deny any application upon review. Appeals or requests for reconsideration must be in writing and include the reason for the request.