Charity Care Policy and Application
Thank you for choosing Advocate for your health care needs. Advocate strives to provide quality health care to meet the needs of the communities it serves.
Our records indicate that you do not have health insurance coverage for your services. It is the policy of
Advocate Health Care to provide financial assistance to patients in need, and enclosed for your convenience are a
Summary of Advocate’s Charity Care Policy and Charity Application (with return envelope). Advocate hospitals will provide medically necessary services free-of-charge, or at a reduced amount, to eligible individuals. Pursuant to State
Law, we allow a maximum of 60 days following the date of service or discharge to apply for assistance. We may be able to assist you even if this 60 day deadline has passed.
Insured Patients: If our records are incorrect and you do have insurance coverage, please provide us with the information found on the front and back of your insurance card. Once received, we will bill your health insurance plan and send you a statement for the remaining balance. An insurance information update form and return envelope are attached for your convenience. In some cases, an insured patient may be eligible for charity care for the balance outstanding after payment by their health insurance. Please stop by or call a financial counselor to receive more information regarding this aspect of the Charity Care Policy.
Uninsured Patients: There are two ways uninsured patients can qualify for financial assistance: “Presumptive
Eligibility” or Family Income Level.
Presumptive Eligibility: Uninsured patients who demonstrate one of the Presumptive Eligibility criteria listed on the enclosed Summary individually or through the benefits provided to their Family are automatically eligible to receive free care and no proof of income will be requested.
We verify eligibility electronically when possible, but may need you to assist us to demonstrate your eligibility. Some examples of documents which we may ask you to provide are:
Award letter
Statement from Grant Agency
Rent receipt in the case of state or federally subsidized housing program
Any other document which shows you meet one of the presumptive eligibility criteria.
Personal statement /attestation
Charity Care based on Family Income: Please refer to the Summary for more information regarding eligibility and benefits under this part of the Charity Care Policy.
If you complete the Charity Application, please provide one or more of the following for each family member:
Current tax return
W2 or 100 form
Recent pay stub
Personal statement or attestation.
Payment Plans: Patients that do not qualify for charity care may still be considered for a payment plan. If you anticipate difficulty paying this bill and would like more information about payment options that may be available to you, please stop by or call a financial counselor. You may also call our Customer Service Department if you have additional questions or concerns.
Effective 5/1/2014

SUMMARY OF ADVOCATE HEALTH CARE
CHARITY CARE POLICY FOR UNINSURED PATIENTS
IMPORTANT: YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE
Note: If you are insured, you may also be eligible for financial assistance. Please contact our office to speak with a financial counselor.
If you have previously submitted a charity care application in the past 60 days and would like to know the status, please call the Financial Counselor. You do not need to submit another Charity Care Application.
It is the policy of Advocate Health Care to provide financial assistance to patients in need. Our records indicate that you do not have health insurance coverage for your services. Advocate hospitals will provide medically necessary services free-of-charge, or at a reduced amount, to eligible individuals. Pursuant to State Law, we allow a minimum of 60 days following the date of service or discharge to apply for assistance. We may be able to