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Services | Charity Assistance Program Policy

At SwedishAmerican we provide treatment, prevention and education of exceptional quality, value and service to our patients. We will provide medically necessary services, within our capacity, to our patients regardless of their ability to pay. If you feel you need help to pay for your hospital services, please contact our Business Office in confidence at (815) 391-7380 to request information about our charity assistance program.


To establish guidelines to evaluate patients, who are having hospital licensed services, for charity assistance.


This policy affects all employees who communicate with patients about charity assistance.


It is the responsibility of the Patient Accounting Department to administer this policy.


SwedishAmerican Hospital provides medically necessary healthcare regardless of the patient’s ability to pay. Patients residing in the State of Illinois may receive charity assistance for hospital licensed services if they meet the criteria outlined below. Patients outside of the State of Illinois are encouraged to seek treatment at an appropriate facility located within their geographic proximity. Exceptions may be made at the sole discretion of the Hospital.

  1. When a patient indicates an inability to pay for hospital licensed medically necessary services, they will be asked to complete a financial disclosure form and submit supporting documentation. Applications may be taken over the phone and information verified through other means such as a credit report, the patient receiving other government assistance such as food stamps, housing assistance, healthy mom coverage, etc., in order to encourage patients to apply for assistance.
  2. If there is a reasonable indication that a patient may qualify for any other available funding, it must be pursued by the patient before consideration would be given for a charity assistance.

The following guidelines will be used to determine eligibility for charity assistance:

All Patients

  1. All patients, insured and uninsured, that are at or below 200% of the federal poverty level and do not have sufficient non-exempt assets to cover their outstanding balance or a portion of their outstanding balance and meet all of the other requirements may qualify for 100% charity. Charity applies to the balances remaining after the full amount due from the insurance company has been received by the Hospital.
  2. Patients have 60 days from the date of service or 60 days from the date their insurance paid to apply for charity assistance. Information requested must be provided within 30 days of the request. Patients that do not apply within the 60-day timeline do not qualify for charity. Exceptions may be made at the discretion of the Director of Business Office Operations or their designee.
  3. The patient must cooperate in applying for any other available funding if there is a reasonable indication that they may qualify. This would include Cobra, Medicaid, Medicare, Worker Compensation, liability, Crime Victims, group insurance, auto insurance, etc.
  4. Family size, which is used in the calculation to determine eligibility, is based on the number of Federal exemptions the family qualifies for at the time of service.
  5. The patient must have a permanent address in the State of Illinois and proof of Illinois residency may be required. Acceptable forms of verification are:
    1. A valid state-issued identification care;
    2. A recent residential utility bill;
    3. A lease agreement;
    4. A vehicle registration card;
    5. A voter registration card;
    6. Mail addressed to the patient at an Illinois address from a government or other credible source;
    7. A statement from a family member of the patient who resides at the same address and presents verification of residency; or
    8. A letter from a homeless shelter, transitional house or other similar facility verifying that the patient resides at the facility.
  6. Accounts that are assigned to a collection agency or assigned for legal action are not eligible for charity assistance. Exceptions may be made at the sole discretion of the Director of Business Officer Operations or their designee.
  7. Patients will be notified by letter of their approval or denial for charity assistance. Patients must apply for charity on all future services.

Uninsured Patients (as required by Illinois Public Act 095-0965)

  1. An uninsured patient is defined as an Illinois resident who is a patient of a hospital and is not covered under a policy of health insurance and is not a beneficiary under a public or private health insurance, health benefit, or other health coverage program, including high deductible health insurance plans, workers’ compensation, accident liability insurance, or other third party liability.
  2. Uninsured patients who are residents of Illinois and apply for charity assistance will be given a charity discount if the family income at the time of service is between 0% and 600% of the federal poverty income guidelines. Proof of income (tax return, pay check stubs, Social Security statement, W2, 1099, income verification letter from employer, etc.) may be required. The charity discount will be determined in accordance with PA 095-0965.
  3. At the discretion of the Director of Business Office Operation or their designee, external sources such as credit reports, the patient receiving other government assistance such as food stamps, housing assistance, healthy mom coverage, etc. may be used as proof of the uninsured patient meeting the income guidelines.
  4. If all of the above criteria are met for a patient meeting the definition of uninsured, then a charity discount will be granted.
  5. The maximum amount that may be collected in a 12-month period from a patient, determined to be eligible for charity assistance, is 25% of the family’s annual income (at the time of service) and is subject to the patient’s continued eligibility for charity assistance as defined above.
    1. This maximum collection limitation will not apply to an uninsured patient who owns assets having a value in excess of 600% of the Federal Poverty level (excluding the patient’s primary residence, personal property exempt under Section 12-1001 of the Code of Civil Procedure; or any amounts held in a pension or retirement plan where patient receives no payments that may be included as income).
    2. Proof of asset ownership and valuation may be required by the hospital. Such proof includes: statements from financial institutions, third party verification of value, or if no other value certification exists, a certification of the estimated value of the asset.
  6. The Director of the Patient Accounting Department or Patient Accounting Department Supervisor or their designee will approve or deny applications for charity.
Contact Us
SwedishAmerican Medical Center/Belvidere
1625 South State Street
Belvidere, IL 61008
(815) 547-5441


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