Patient Financial Assistance

Patient Financial Assistance

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Financial Assistance is available to patients that qualify in accordance with the IMH Patient Financial Assistance Program Policy and Financial Assistance Plain Language Summary.

The form requests information about employment, health insurance, family size, family income as well as verification of income. Completed applications will be reviewed and verified by our Business Office. A determination will be made based upon the information provided and a sliding scale based on federal poverty income guidelines.

Patients/guarantors who are approved for financial assistance will be notified of the amount of reduction and the patient/guarantor portion due. If financial assistance is denied, patients/guarantors will be notified of the reason for denial. Each application for financial assistance will be considered effective for twelve (12) calendar months from the date of the eligibility determination.

All financial assistance forms are available below and from the IMH Business Office by calling 815.432.7706.

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