Financial Assistance
The Financial Assistance Program is administered by the Patient Financial Services department. The staff of the Patient Financial services department, in their patient account billing and collection responsibilities, has a unique opportunity as hospital representatives to identify potential candidates for financial assistance. Patient Financial Services staff may identify candidates at any time throughout the account process, such as: during insurance verification, IDPA Medical Assistance Application, post insurance payment and self pay collections. Due to the sensitive nature of these requests, all communications with the patient of family member/representative will be handled in strict confidence and in a compassionate manner.
A. Requests for financial assistance may be initiated by any of the following individuals and at any point during the cycle of the patient’s account.
- Patient/guarantor.
- A representative for the patient/guarantor.
- A hospital representative on behalf of the patient/applicant.
- Patient’s attending physician.
B. The Loretto Hospital
application for financial assistance must be completed and signed by the patient/guarantor/representative. The Hospital’s Financial Services staff will assist the applicant in the process. Applications are considered complete when all the necessary documentation is provided. Applications without sufficient documentation will be pended until the required documentation is received or denied if not received after reasonable attempts have been made.
If the patient is deceased and a responsible party is not identified, a hospital representative may generate the request and complete the application using available information and documents
(e.g., IDPA spend down form, estate document, etc.)
Family income is defined as those earnings which are reportable to the federal government. Income documentation is defined as one or more of the following and must be provided prior to the adjudication of the application:
- Prior year’s income tax return
- Most recent W-2 form
- Paycheck stubs or employer statement documenting wages for three or more months prior to the application for assistance.
- If no documentation is available, a signed statement which testifies to the patient’s financial status may be provided by the person(s) providing financial support to the patient.
- IPDA eligibility documentation
- Print out from the Credit Bureau
The amount of financial assistance approved will be determined using guidelines which include, but are not limited to income, assets and expenses. Annual family income is evaluated using the Financial Assistance Program guidelines, and will be adjusted based on family size, health care expenses and other extenuating circumstances. Current and anticipated assets and expenses will be considered during the evaluation process.
Patients that are currently covered under General Assistance with Illinois Department of Public Aid are considered as eligible for Financial Assistance. Patients have already proven financial verification to Public Aid and are receiving only food stamps and $100.00 per month in cash.
Completed and approved applications are maintained along with a monthly printout indicating accounts written off for the month. The Financial Services staff submits the Charity Documents application with attachments to the Patient Financial Services Director for review.
The Patient Financial Services Director evaluated the request and makes a recommendation based on the patient’s circumstances and the current Financial Assistance Program guidelines.
If the request is greater than the Director’s approval limit, the recommendation and documents are submitted to the hospital’s Chief Financial Officer.
Remaining patient balances should be scheduled for payment over a period not to exceed twelve months.
If you have any questions, please call our Financial Counselor at
773-854-5065.