Christian Assistance Program
Financial assistance for those in need
At St. Elizabeth’s Hospital, we are concerned about our patients and their families. We understand that healthcare expenses are often unexpected and paying for services can be overwhelming. This is especially true if you do not have health insurance. St. Elizabeth’s Hospital has developed a program to assist the uninsured and financially indigent.
Eligibility for this program is determined through guidelines designed to ensure our limited resources are allocated to those patients who are least able to pay.
To apply:
-
Download and complete the Christian Assistance Application Form (Word Document)
and return it by the deadline date. - Provide evidence that all other sources of assistance have been pursued, including private insurance and public aid, where appropriate.
- Provide a list of your assets
- Provide a list of your monthly expenses.
-
Provide documentation* of all household income in the past 12 months. If you are scheduled to begin a new job, proof of future income should also be submitted.
*This documentation should be copies of all applicable documents listed below:
- Your most recent federal and state income tax returns.*
- Your W2 withholding statements.*
- Your payment stubs from the past three months, or a written statement from your employer verifying your earnings for the past three months.*
- Your checking and savings account statements from the past three months.*
- Your monthly social security benefit statements and/or other monthly retirement statements.
- Unemployment/workers compensation check stubs
- Alimony/child support statements
- A letter from any person(s) providing you with support if you are currently unemployed.
*Required for processing application
NOTE: Please do not submit original documents; they will not be returned.
If you qualify
You will be notified in writing of your eligibility and the amount of assistance allowed. Your bill will then be adjusted and a payment plan established for your remaining balance, should one exist.
If you don’t qualify
You will be notified in writing with an explanation for your ineligibility and will be required to make arrangements for paying your bill. Applicants can reapply for assistance if their financial situation changes.
If you believe you qualify for charitable care, please call (618) 234-8600 for additional information.
