Applications are available upon request if you are uninsured or underinsured and need assistance in paying balances due for Inpatient and Outpatient hospital services and for any services received in any of our clinics: Ferrell Hospital Family Practice, Eldorado Family Medicine, and Carmi Family Medicine.
Insured individuals with catastrophic medical and financial situations may also be eligible. Based upon supporting documentation provided and if the patient's household income is below 200% of the Federal Poverty Levels you may be eligible for a full or partial reduction of the balance you owe.
Illinois Uninsured Patient Discount Act
An uninsured patient who meets certain income requirements may qualify for an uninsured discount. The patient must be an Illinois resident and not covered under any health insurance policy, including high deductible health plan, work comp, or accident liability insurance. The patient must have a household income at or below 300% of the Federal Poverty Level.
The patient must submit a completed application within 60 days from the date of service. If the submitted application is incomplete, the patient has an additional 30 days from the date of request to supply required documentation.
The Patient Financial Assistance Application is available via the website link below or upon request by contacting one of our Patient Financial Counselors at 618-273-3361
ext 381 or 383.
Completed applications can be submitted as follows:
- In person to the Patient Financial Counselor at Ferrell Hospital Community Foundation
- By fax to 618-273-2504 - Attn: Patient Financial Counselor
- By mail to:
- Ferrell Hospital Community Foundation
- 1201 Pine Street
- Eldorado, IL
- Attn: Financial Counselor
- By email to firstname.lastname@example.org