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Financial Assistance

Financial Assistance Summary

Patients who meet certain income guidelines may qualify for financial assistance, including reduced hospital charges and payment plans. Patients who are eligible for financial assistance will be billed less than the amounts generally billed to individuals who have insurance covering such care.

Wabash General Hospital will provide, without exception, care for emergency medical conditions to all patients seeking such care, regardless of ability to pay or to qualify for financial assistance, in accordance with the requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA).

Financial Assistance is available only for emergency and medically necessary services. It does not apply to elective procedures. It also does not apply to the portion of your services that have been paid for by a third party such as an insurance company or government program.

The amount of financial assistance you receive is based on Federal Poverty Level information set by the U.S. government each year. In addition to your income, the discount will also take into account the size of your family. Services which are separately billed by other providers, such as independent physicians, are not eligible under Wabash General Hospital’s Financial Assistance Policy.

You may apply for financial assistance at any time – before, during or after your care, up to 240 days after your initial bill. The application requires proof of income such as an income tax return or paycheck stub. Patients who are eligible/enrolled in Medicaid automatically qualify for financial assistance for emergency and medically necessary services that are not covered by Medicaid. In addition, patients may be approved for additional financial assistance based on the patient’s financial and/or socio-economic position. Eligibility for this type of assistance does not automatically qualify the patient for assistance on future accounts.

You must meet and verify income requirements. View the Charity Income Guidelines for Wabash General Hospital.

Proof of Income

The following are examples of acceptable proof of income used for the determination of Charity Care. At a minimum, 2 forms of proof of income are required. It is at the discretion of Wabash General Hospital to determine acceptable proof of income.

  • Current Federal Income Tax
  • W-2
  • Letter showing current eligibility for assistance
  • Current Pay Stubs
  • Unemployment Compensation Letter/Notice
  • Recent LES for Military Personnel
  • Divorce Decree
  • Copy of Student Financial Aid Application with determination notice
  • Food Stamp Document showing current eligibility
  • Social Security Administration Benefit Letter
  • Current Bank Statements (Past 3 months)

The Patient Financial Assistance Application and Wabash General Hospital’s Financial Assistance Policy is available via the link below or upon request by contacting the Business Office at (618) 263-6379.

Financial Assistance Application Form

Spanish Financial Assistance Application Form (En Espanol)

Financial Assistance Policy

Completed applications can be submitted as follows:

  • In person to the Business Office at Wabash General Hospital
  • By fax to (618) 263-6467- Attn: Business Office
  • By mail to:
Wabash General Hospital
Attn: Business Office
1418 College Drive
Mount Carmel, IL 62863

To review Your Rights and Protections Against Surprise Medical Bills, please click here.


Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • Initial notice of the Good Faith Estimate may be given verbally if the health care provider can reach you by phone. The written copy of the Good Faith Estimate may be given to you electronically via your patient portal, secure email, or secure text attachment. If not sent electronically, a printed copy will be placed in the regular mail to the address you have provided. Efforts will also be made to provide you with another copy of the Good Faith Estimate upon arriving to register for the scheduled service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • To obtain a blank copy of our Good Faith Estimate form, please click here.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit or call 1-800-985-3059.

Your Rights and Protections Against Surprise Medical Bills

To review Your Rights and Protections Against Surprise Medical Bills, please click here.