Financial Assistance Program Application Process

Patients & Visitors > Billing & Insurance > Financial Assistance > Financial Assistance Program Application Process

As a healthcare institution, we pride ourselves with providing quality care, and recognize the financial needs within our community. To ensure our patients have access to the best care, Morris Hospital offers assistance to those patients and family members who cannot pay for part or all of the care they receive.

You may be able to receive free or discounted care. Please complete and submit Morris Hospital’s financial assistance application in order to find out if you can receive free or discounted services or other public assistance that can help cover your healthcare needs.

FINANCIAL ASSISTANCE GUIDELINES

FINANCIAL ASSISTANCE GUIDELINES SPANISH

To apply for financial assistance at Morris Hospital & Healthcare Centers, please complete a Financial Assistance Application and submit it to our Patient Financial Services office. To request an application form by mail, call Patient Financial Assistance at 815-705-7046.

ENGLISH

Financial Assistance Summary

Financial Assistance Policy

Financial Assistance Application

SPANISH

Resumen De Asistencia Financiera

Politica De Asistencia Financiera

Solictud De Asistencia Financiera

Along with the application, please supply copies of: (1) Your most recent tax return; (2) Two of your most recent pay stubs; and (3) Written income verification from your employer if paid in cash.

Your application should be completed and submitted to the Patient Financial Assistance office in person, by email to [email protected], or by fax to 815-941-2476 within 60 days following the date of discharge or receipt of outpatient care.

Eligibility

Eligibility for financial assistance is determined for the patient primarily on income and size of family.

The patient must acknowledge that he or she has made a good faith effort to provide all information requested in the application to assist the hospital in determining whether the patient is eligible for financial assistance.

The patient may automatically qualify for eligibility criteria established in Section 4500.40 by virtue of the patient’s family income. The patient shall not be required to complete the portions on the application.

Social Security Number

If you are uninsured, a Social Security number is not required to qualify for free or discounted care. However, a Social Security number is required for some public programs, including Medicaid. Providing a Social Security number is not required, but it will help the hospital determine whether you qualify for public programs.

Continuing Eligibility

If a patient has obtained financial assistance within the last 12 months and the patient’s financial circumstances, family size, and medical coverage have not changed, the patient shall be deemed eligible for financial assistance without having to submit a new “Patient Financial Worksheet.” Income verification in the form of paycheck stubs, income tax returns, Social Security, unemployment benefits and/or credit report may still be necessary. If during the 12-month period additional hospital charges are incurred, the patient should contact a financial representative at Morris Hospital to verify financial assistance status.

Notification

Within 30-40 business days after receiving the completed application and any required supporting materials, Morris Hospital will notify the applicant in writing as to whether the applicant qualifies for financial assistance. Accounts will not be turned over to a collection agency during the financial assistance application process.

Appeal Process

If financial assistance is denied, reasons for the denial shall be provided in writing and the applicant shall be informed of the appeal process. The applicant may petition the hospital, in writing, within 30 days for reconsideration. In the letter, the applicant may dispute any of the reasons he or she was denied financial assistance and list any extenuating circumstances that were not documented in the original Patient Financial Worksheet. Appeals will be reviewed by the Patient Accounts Manager and Vice President of Finance.

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