Financial Assistance Information

Plain Language Summary

Updated April 2021

Eligibility Requirements and Assistance Offered Under the Financial Assistance Policy 

• Patients whose household income is at or below 200% of the Federal Poverty Level are generally eligible for free emergency and medically necessary care. 
  
  
• Patients whose household income is between 201% and 300% of the Federal Poverty Level are generally eligible for a 70% discount for emergency and other medically necessary care. 
  
  
• Patients whose household income is between 301% and 450% of the Federal Poverty Level are generally eligible for a 55% discount for emergency and other medically necessary care. 
  
  
• Patients whose household income is between 451% and 600% of the Federal Poverty Level are generally eligible for a 38% discount for emergency and other medically necessary care. 
  
  
• A patient who qualifies for assistance under TRH’s Financial Assistance Policy will not be charged more than amounts generally billed to patients with insurance, for emergency or medically necessary care. 

How to Apply for Financial Assistance 

To apply for financial assistance, please submit a completed Financial Assistance Application & supporting documentation to Financial Assistance department, either by email to amerten@touchette.org, by mail, or in person at Touchette Regional Hospital, Financial Assistance, 5900 Bond Ave, Centreville, IL, 62207. For assistance call 618-332-5389. To be considered complete, an application must include: 

•  Completed Financial Assistance Application 
  
  
•  Approval/Denial letter from Medicaid 
  
  
• Verification of current income, if applicable: examples include a most recent pay stub, pension and retirement income, Social Security income, unemployment compensation, workers’ compensation, veterans’ payments, etc. 
  
  
• Proof of income from interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, and any other misc. income sources Other documentation may be requested to verify information on the Financial Assistance Application. 
  
  

How to Obtain Copies of the Financial Assistance Policy and Financial Assistance Application 

Copies of the Financial Assistance Policy, this plain language summary, and the Financial Assistance Application are available free of charge upon request to Financial Assistance department, 618-332-5389, or the Patient Financial Services Department 618-482-7128. Copies can also be found in the admitting/registration areas of the hospital or on our online pdf. 

Further information and complete details about the Financial Assistance Policy may be obtained by calling 618-332-5389, visiting our website at https://touchette.org/financial-assistance, or in-person at the address above. 

Payment Policy

Effective March 1, 2009 / Revised 2021

Outpatient Elective Services

Patients presenting for these services will be responsible on the day of the visit to pay either their insurance co-payment or the non-refundable hospital deposit as set out below if not qualified for 100% Financial Assistance. Whenever possible, patients will be pre-advised of their obligations prior to presenting.

Important:

Any co-payment or non-refundable hospital deposit does not constitute payment in full. Final billing for the remaining costs will be mailed to each patient and/or the responsible party for payment. Outpatient Services may be postponed if the payment requirements cannot be met and are not identified as a stat order.

-- Unscheduled Ancillary Services:
   $15 per service

-- Archview Office Visit:
   $25 per visit (or co-pay as determined by insurance)

-- Scheduled Recurring Services:
   $15 per service

-- Pre-Surgery Ancillary Services:
   No Deposit Required

Scheduled Ancillary Services:

-- Cardio / EKG:
   $25

-- Cardio / Echo:
   $150

-- Cardio / Stress:
   $100

-- Radiology / X-Rays:
   $30

-- Radiology / CT’s:
   $100

-- Radiology / Ultrasounds:
   $40

-- Radiology / MRI’s:
   $450

-- Radiology / Mammograms:
   $30

Surgery (as determined by your physician):

-- Intensive:
   $240 and Anesthesiologist $300

-- Moderate:
   $120 and Anesthesiologist $200

-- Low:
   $100 and Anesthesiologist $100

-- Very Low (Scopes):
   $75

Specialty Services:

-- Cosmetic Procedures:
   7% of Estimated Gross Charges                                                            

Emergency Department Services:

Services will be provided prior to a request for payment. After services have been provided, patients may be requested to provide their co-pay or a deposit on the services rendered if they have been determined to not qualify for Financial Assistance. The patient may also be asked to set up a payment arrangement for a future date.

-- Emergency Room:
   $100 per visit (or co-pay as determined by insurance)          

Policies & Applications:

• Financial Assistance Policy
• Billing Policy
• Pricing Transparency
• Financial Assistance Application (English)
• Financial Assistance Application (Spanish)