Patient Financial Services


Financial Assistance Program Policy (Spanish)
Billing & Collection Policy (Spanish)
Emergency Medical Care Policy (Spanish)

The Mission of Financial Assistance

HSHS Holy Family Hospital offers a Financial Assistance Program for those with limited financial resources. Holy Family is a Christian-based facility that provides medical care regardless of race, creed, color, sex, national origin, sexual orientation, handicap, age, or the ability to pay. We respect the medical needs of all people who come to our doors and the financial concerns of those with limited resources.

Holy Family understands that patients with limited financial resources have the obligation and willingness to pay, but not always the ability to pay.

About the Financial Assistance Program
Holy Family offers the Financial Assistance Program to all patients who show financial need. Holy Family has designated funds to aid patients who are unable to pay their obligation in full. Eligibility requirements have been set for those who request financial assistance. The guidelines are not meant to discourage anyone from seeking treatment. But they are designed to ensure the hospital’s resources are used for the people who need them most and who are the least able to pay.

Applying for the Financial Assistance Program
We want to assist you in finding the best possible solution for you and your family. Before applying to the Financial Assistance Program, a Patient Account Representative will first help you explore all possible options for financial assistance.

Financial Assistance Application

Financial Assistance Brochure

To Apply:
Call our Business Office at 866-973-7134 or 618-664-1230, Ext. 8443.
Please provide copies of the following items:

  • W2 withholding statements.

  • Most recent federal/state income tax forms.

  • Paycheck/Unemployment check stubs (past 3 months) or written statement of earnings from your employer (past 3 months).

  • Forms approving or denying Unemployment, Workers Compensation or Assistance from the Department of Public Aid.

  • Statement of annual benefits from Social Security.

  • Checking/savings account statements (past 3 months).

  • Other: letter explaining your situation.

Additional eligibility criteria may be available to you. Contact our Business Office at 866-973-7134 or 618-664-1230, Ext. 8443 for more information

Your Patient Account Representative can help you complete the form.

Eligibility Guidelines
Income guidelines for eligibility are adjusted annually based on the Federal Poverty Guidelines established by the United States Department of Health and Human Services and published periodically in the Federal Register.

These guidelines are subject to change without notice.

If You Qualify

  • Applicant will be notified in writing that they are eligible and what amount of assistance has been allowed.

  • Adjustments will be made to bill and payment plan will be established on remaining balance, if one exists.

  • Applications will be held on file and will remain valid for six (6) months for future visits.

If You Do Not 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 with 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 866-973-7134 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