Financial Assistance for Healthcare
Our mission includes providing necessary healthcare to the people in the FHN service area who may be experiencing a hardship. To fulfill this commitment, the FHN Assisted Care Program provides financial assistance to those who are uninsured or under insured who also meet geographic and income and financial requirements (based on family size).
Eligibility includes gross income and assets at or below 300% of the federal poverty guidelines. You will be required to make a copayment, and in some cases depending on your eligibility level, you will need to pay a percentage of the charges. Your co-payment(s) will be required at the time of service.
How to Apply
You may apply for FHN Financial Assistance Program(s) at any FHN location. To be considered for the program(s), you must complete an application and provide supporting documentation requested on this checklist.
YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE: Completing this application will help FHN Memorial Hospital determine if you can receive free or discounted services or other public programs that can help pay for your healthcare. Please submit this application to FHN.
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 will help the hospital determine whether you qualify for any public programs.
FHN administers the Illinois Hospital Uninsured Patient Discount Act, a state assistance program which provides varying discounts to those applicants who qualify and whose gross income and assets are at or below 300% of the federal poverty guidelines. Additional program requirements include IL residency, application for the discount within 60 days of the service date and the discount is for medically necessary services exceeding $300.
Additionally, FHN provides a discount of 20% to all uninsured patients. This discount will appear automatically on your billing statement as long as you are without insurance. This discount is provided regardless of your poverty level and is not combined with any other uninsured discounts.
Patients can call Customer Service at 1-877-720-1555 with questions or to make an appointment with a financial counselor.
Financial Assistance Policy
FAP Providers covered
FAP Providers not covered
Fair Billing and Collection Policy
Plain Language Financial Assistance Summary
Health Information Authorization Form
Application - Spanish
Checklist - Spanish
Financial Assistance Policy - Spanish
FAP Providers covered - Spanish
FAP Providers not covered - Spanish
Fair Billing and Collection Policy - Spanish
Plain Language Financial Assistance Summary - Spanish
Health Information Authorization Form - Spanish