Charity Assistance and Illinois Uninsured Discount

Dear Patient:

The philosophy of OSF HealthCare is that all people have a right to receive needed health care. Our doors are open to persons of every faith and ethnic background regardless of their ability to pay.

We provide help to patients in obtaining payment from third parties such as Medicaid and Medicare. If you are eligible for Medicaid, and you are not currently signed up, we can help you apply.

We also offer charity assistance for medically necessary health care services to persons who meet our financial terms provided they submit the needed documents. OSF Charity Assistance may be applied for when there is a balance still due on an account after we have received payment from third party payers (like Medicaid, Medicare or an insurance company) and you feel you cannot pay the full balance.

The PDF form available through the links below must be completed and signed by you. We use income guidelines established by the U.S. Department of Health and Human Services to determine if you are eligible for charity care. We do verify assets regarding your eligibility. So, please provide all the information promptly so we may try to help you as quickly as possible.

For more information, please call your patient accounts representative between the hours of 8 a.m. and 4:30 p.m. Monday through Friday. Phone numbers for each facility are located inside the application PDF.

OSF HealthCare offers high quality health care and we were pleased to provide that to your family. We look forward to working with you further to make sure the financial aspects of your care are handled in the same high quality way.

Sincerely,
The Sisters of the Third Order of St. Francis

Click below to download and print the OSF Charity Assistance PDF form.*

English Version
Spanish Version

*Please Note: These PDF forms allow you to fill out the fields on-screen then print, making the application easier to fill out and ensuring readability.

Illinois Uninsured Discount

Learn more about the Illinois Uninsured Discount, effective April 1, 2009 and download application for use at OSF Saint Anthony Medical Center.