Qualify for Assistance
Call our local financial counselor at 618-690-3443. You may also contact our Illinois Single Billing Office at 1-877-636-2261
Please provide copies of the following items:
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W2 withholding statements.
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Most recent federal/state income tax forms.
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Paycheck/Unemployment check stubs (past 3 months) or written statement of earnings from your employer (past 3 months).
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Forms approving or denying Unemployment, Workers Compensation or Assistance from the Department of Public Aid.
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Statement of annual benefits from Social Security.
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Checking/savings account statements (past 3 months).
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Other: letter explaining your situation.
Your Patient Account Representative can help you complete the form.
Additional eligibility criteria may be available to you. Please call our local financial counselor at 618-690-3443. You may also contact our Illinois Single Billing Office at 1-877-636-2264 for more information.