Financial Assistance

 

As part of the Mission of St. Joseph’s Hospital, “to minister to those in need as exemplified by the Gospel of Christ,” we have established financial assistance programs to help patients and families who are unable to pay for the services they have received.

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.

Financial Assistance Brochure

 

To Apply:

  1. Download and complete the Financial Assistance Application Form (PDF) and return it by the deadline date, as stated on the form.
  2. Provide evidence that all other sources of assistance have been pursued, including private insurance and public aid, where appropriate.
  3. Provide a list of your assets
  4. Provide a list of your monthly expenses.
  5. 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. NOTE: Please do not submit original documents; they will not be returned.
  • 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

 

Where to Send Application:


Send completed application with copies of all requested documentation to:
Patient Accounts Department
Attention: Financial Assistance Program
211 South Third Street
Belleville, IL 62220
(618) 234-8600

 

If You Qualify:

  • Applicant will be notified in writing that they are eligible and what amount of assistance has been allowed.
  • Adjustment will be made to bill and payment plan will be established on remaining balance, if one exists.
  • Application will be held on file and will remain valid for six (6) months for future visits.

If You Don’t Qualify:

  • Applicant will be sent a letter stating the reason for ineligibility along with an itemized statement.
  • Applicant must make financial arrangements to pay the enclosed statements with a patient account representative within ten (10) business days or the balance will be due within thirty (30) days.
  • Applicants are eligible to reapply for assistance if their financial situation changes by calling the business office at 618-234-8600 for reevaluation of eligibility.


If you have any questions or concerns about your billing statement or you require financial assistance, please contact our Business Office.
 
Patient Account Representatives
618-234-8600

Application