Healthcare Assistance Program
Southern Illinois Healthcare and its hospitals care about you. If you believe you will not be able to pay your bill, ask for help from the SIH Healthcare Financial Assistance program, ideally before you get care. Southern Illinois Healthcare provides the same quality of care to all people regardless of their ability to pay, so asking for assistance will not affect your care.
Southern Illinois Healthcare also reserves the right to decide that a patient should have financial assistance for care if he or she is in an unusual situation such as being homeless, living in a shelter facility or is a victim of rape or other violent crime.
For more information about the SIH Healthcare Financial Assistance Program or for assistance completing the application, please speak with a SIH Financial Counselor.
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, Department of Public Aid, alternative financing and/or payment arrangements.
To process a request for assistance, please submit following information:
- A completed Healthcare Assistance Program application.
- Legible, signed and dated.
- Reviewed by you for accuracy prior to submission to the Financial Counselor.
- A copy of your last year’s complete federal tax return.
- If self employed you must include Schedule C.
- Please include a copy of your W2.
- 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 90 days. We accept the following as proof of wages:
- An employee wage form signed by employers for each wage earner.
- Copies of check stubs for the last 90 days.
- A print out of your wages from your employer for the last 90 days.
- If applicable, proof of participation in Governmental assistance programs such as:
- Food Stamps
- If you do not have a current acceptance or denial letter from the Department of Public Aid, please complete the Determination for Medicaid Eligibility form (staff is available to help you complete the Medicaid Eligibility form). You may be asked to apply for assistance from other appropriate sources if it is determined you could qualify.
Completed applications may be mailed or submitted directly to a Patient Financial Counselor at any hospital. After submission no changes or reapplication will be allowed. Appeals or requests for consideration must be in writing within 30 days of notification. Appeals or requests must include the reason for the request or must provide additional reasoning for review. Only one application is required if you have accounts at any or all of the SIH hospitals.
Completion of this application does not relieve you of your financial obligation to Southern Illinois Healthcare; SIH reserves the right to deny any application upon review.