Sacred Heart About Us Financial Assistance Program

Financial Assistance Program

What is Financial Assistance?

Financial Assistance is a hospital-based program to provide full or partial discounts on HSHS Sacred Heart Hospital services to patients. Guidelines have been established to ensure that our limited resources are used to treat patients who are unable to contribute to the cost of hospital services.

Download our Financial Assistance Program Brochure

* Spanish version of brochure

Who is eligible for Financial Assistance?

Patients of Sacred Heart Hospital may be eligible for Financial Assistance if they:

Have no health insurance coverage;
Are not eligible for any private or governmental sponsored coverage (such as Medicare, Medicaid, Badger Care, etc.);
Have health insurance coverage, but are responsible for co-insurance, deductible, or other non-covered medically necessary services; and,
Meet certain income and asset eligibility criteria.

What guidelines are used to determine household income and assets?

Please see the income, assets and income guidelines information below.

Income Guidelines

Household income is based upon current Department of Health and Human Services Federal Poverty Guidelines. There are limits on the amount of assets you or your family members can own to be eligible for Community Care. Assets include: cash, savings and checking accounts, certificates of deposit, stocks and bonds, mutual funds, retirement accounts, trust funds, and real estate. Proof of income and assets is required (see below). Please see the income, assets and income guidelines information below.

Proof of income

The following documents must be provided as proof of income for you and your family members:

Federal or state income tax returns;
Pay check stubs with year–to-date earnings (3 most recent) (employer and unemployment);
Statement of income from any private or government agency that provides you benefits (pension, grants, scholarships, workers compensation);
Proof of year-to-date child support or alimony payments.
Annual statement of Social Security benefits, or bank statements that show the direct deposit;
Correspondence from governmental agency approving or denying financial assistance.

Proof of assets

The following documents must be provided as proof of assets for you and your family:

Checking and savings account statements (3 most recent months)
Account statements for certificates of deposit, stocks and bonds; mutual funds, retirement accounts, and trust funds (3 most recent months);
Property tax statement for all real estate, including rental property

What services are covered?

Financial Assistance is limited to Sacred Heart Hospital charges and does not include physician, anesthesiologist or professional charges.
Financial Assistance is not offered for cosmetic, elective or experimental procedures. If approved, Financial Assistance will remain in effect for services provided within 6 months of the approval date.

How do I apply for Financial Assistance?

You will be required to complete a Financial Assistance Application and provide copies of documents requested. All information must be returned within fourteen days of receipt.

* Spanish version of application

How will I find out if I qualify?

You will be notified by mail if you are eligible for Financial Assistance within 30 days of receipt of all required information.

If you qualify for Financial Assistance:

You will be notified by mail of the amount of Financial Assistance granted.
If you are eligible for partial Financial Assistance, you are responsible for the remaining balance, which must be repaid in accordance with Financial Payment Options.
You will be required to reapply for Financial Assistance for services provided 6 months after receipt of your approval.

Who can I contact with questions?

If you have any questions about Financial Assistance, feel free to contact our Patient Financial Services department between 8am - 4:30pm Monday through Friday at:
715-717-4141 or toll-free at 1-888-445-4554, extension 4141.