Financial Assistance

At OSF HealthCare, we believe 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.

In addition to our patient service representatives, OSF HealthCare also has financial navigators in many of our facilities.

These financial navigators are specially trained to help you understand all of the options available to you, so you can choose the one that best fits your needs.

Partnering to Help You

OSF HealthCare partners with MedData to provide free financial advocacy for patients who do not have medical insurance. MedData will work with patients to identify what assistance may be available to them for medical bills.

You may have been referred to MedData if you received care from OSF without insurance, or if a financial counselor identified you may need more insurance coverage.

Contact MedData:

(866) 402-3630 or OSF@MedData.com

Uninsured Discount

Applications
Financial Assistance Application - English
Financial Assistance Application - French
Financial Assistance Application - Polish
Financial Assistance Application - Spanish

Some families may qualify for discounted health care through the Illinois Uninsured Discount Act or Healthy Michigan law.

To determine if you qualify, you will be required to provide proof of income, such as a copy of a tax return or pay stubs, as well as proof of Illinois residency, such as a driver’s license, identification card or utility bill.

Your income will then be compared to federal poverty income guidelines to determine what level of discount (up to 100 percent) you may receive.

Other Financial Assistance

Policies & Information	Downloads
Financial Assistance Policy	English French Spanish
FA Providers List	English French Spanish
Plain Language Summary	English French Polish Spanish
Fair Billing Collection Policy	English French Polish Spanish

In addition to the Illinois Uninsured Discount, OSF HealthCare also offers financial assistance for medically necessary health care services to those who qualify.

This includes the uninsured, underinsured or those who lack the financial resources to resolve bills for service.

All patients are eligible to apply for this assistance.

Like the Illinois Uninsured Discount program, patients will be required to provide documentation of income and family size to determine what level of financial assistance is available.

OSF HealthCare will treat any individuals or families seeking financial assistance with dignity, sensitivity and confidentiality.

Call Center Hours

If you have questions, please call a patient services representative toll-free at (800) 421-5700.

Day(s)	Time(s)
Monday - Friday	8 a.m. - 4:30 p.m.

Submit Application Online

Download the financial assistance application (above) to your computer.
Use Adobe Reader to fill out and save. Note: you MUST use Adobe Reader to fill out.
Fill out the online form below and use the appropriate field to upload your completed application and supporting documents.

* indicates a required field.

First Name: *

Last Name: *

Phone: *
Please provide the best contact number in case our team has any questions.

Email:

Documents

Please include all documents that apply to your current situation.

Application: *
Please attach your completed financial assistance application in PDF format. Combined file sizes cannot exceed 15MB

Paystub 1:
Your most recent paystub, including gross year to date income, from patient and patient’s spouse. If patient is a minor, we will require paystubs from parents or guardians. Combined file sizes cannot exceed 15MB

Paystub 2:
Your second most recent paystub, including gross year to date income, from patient and patient’s spouse. If patient is a minor, we will require paystubs from parents or guardians. Combined file sizes cannot exceed 15MB

1040 Tax Return:
Most recent 1040 Federal Income Tax Return including all schedules (or explanation letter). If a 1040 Federal Income Tax Return has not been filed, please write a letter explaining why not. Combined file sizes cannot exceed 15MB

Social Security Award Letter:
Current Social Security Awards Letter showing gross monthly benefit amounts. To request a new award letter, please call (800) 772-1213. Combined file sizes cannot exceed 15MB

Pension 1099:
Pension 1099 or letter from payer documenting gross monthly award amount. Combined file sizes cannot exceed 15MB

Alimony:
Alimony documents paid or received. Combined file sizes cannot exceed 15MB

Child Support:
Child support documents showing paid or received. Combined file sizes cannot exceed 15MB

VA Benefits:
VA benefits award letter. Combined file sizes cannot exceed 15MB

We respect and safeguard your privacy. This form is secure.