Financial Assistance

Financial Assistance is Available

Thorek Memorial Hospital (TMH) is committed to meeting the needs of everyone in the communities it serves, including those who cannot pay for their care. Therefore, TMH provides finanical assistance to all patients who qualify under its Finanical Assistance Policy (FAP). This is a summary of the policy.

Eligibility Requirements and Assistance Offered

To determine if a patient is eligible for financial assistance, his/her annual income is compared to the current Federal Poverty Guidelines (FPG). Generally:

  • Patients with houshold income less than or equal to 200% of FPG receive free care.
  • Patients with household income over 200% but not greater than 600% of FPG receive discounted care. The discount is based on the Medicare allowable amount, or a percentage of the cost of care, as detailed in the full policy.
  • No patient eligible for financial assistance will be charged more than the Medicare allowable amount for eligible care.
If a patient is eligible for a government-funded program, or has sufficient insurance coverage or assets available to pay for the care, he/she may not be eligible for finanical assistance. 
 
Financial assistance is available for emergency or other medically necessary services provided by TMH. Elective services are not covered. 
 

How to Apply 

Patients may apply for financial assistance by completing the application form and submitting it to TMH using the contact information listed below. Finanical counselors are available to assist patients in completing the application. 

How to Obtain Information - Contact Information 

To obtain information about (or assistance with) the financial assistance process, or to obtain free copies of the FAP, FAP application form, or this summary:

  • Request information in writing by mail or by visiting the TMH Patient Financial Services (Financial Counselor) at 850 W. Irving Park Road, Chicago, IL 60613; or
  • Request information by telephone by calling the TMH Patient Finanical Services (Financial Counselor) at (773) 975-6843, or by fax at (773) 975-3220.
  • Download information online.
    icon Financial Assistance Policy
    icon FAP Plain Language Summary
    icon FAP Application Form

 

Translations

The FAP, FAP application form, and this summary are available in English, Spanish and Chinese.