Criteria for Financial Assistance Eligibility

• Before any financial assistance is granted, you must have already exhausted all other sources of payment including insurance, public assistance, litigation, or third-party liability.
• Family income, in relation to Federal Poverty Guidelines
• Assets (e.g. home, bank account, and stocks)
• Any additional financial hardship
• You must be receiving non-elective, medically necessary care

Please note that Saint Joseph's Hospital reserves the right to run a credit check on any patient in order to verify their financial situation. To download and view Saint Joseph's Policy and Procedures for Charity Care, click here.

• Copy of most recent Federal Tax Return
• Copies of last year’s W-2 forms
• Copies of the three most recent, paycheck stubs or a statement from the employer
• Copies of three most recent bank statements (e.g. savings, checking, money market, IRA, 401K, etc.)
• Copies of Federal Tax 1099 and Profit Loss Statement (If self employed)
• “Letter of Hardship” – Explains a personal and significant reason why a hospital bill cannot be paid (Must be notarized)
• Copies of unemployment, disability compensation benefits statements
• Copies of social security or pension benefits income
• Copy of food stamp allocation
• Copies of government assistance notices (including Department of Health & Human Services)
• Copies of your Medical Visa with a Conversion of Verification of Income in US Dollars (if traveling from outside the US)

If you believe that you may qualify for our financial assistance, please proceed to download this Financial Assistance Application. Please fill this application out before your meeting with a financial counselor.

“Saint Joseph's Hospital is a partner hospital with the Larry King Cardiac Foundation. If you need financial assistance for a cardiac procedure, please visit the Larry King Cardiac Foundation website for more information.”

 Contact a Financial Counselor