{"hospital":{"ccn":"140130","name":"NORTHWESTERN LAKE FOREST HOSPITAL","city":"LAKE FOREST","state":"IL","zip":"60045","phone":"847-234-5600","ownership":"Voluntary non-profit - Other","website_domain":"nm.org","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"250","layer":"documented","quote":"Free Care: Insured Illinois Residents with Household Income of 250% or less of the then current Federal Poverty Guideline applicable to the Applicant’s Family Size, shall be eligible for a 100% discount.","source_id":"fap-8a852ef2e6b5a7fd","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Insured Patient Free And Discounted Care (set forth on Appendix B)","source_id":"fap-8a852ef2e6b5a7fd","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid","Women, Infants and Children Nutrition Program (WIC)","Supplemental Nutrition Assistance Program (SNAP)","Illinois Free Lunch and Breakfast Program","Low Income Home Energy Assistance Program (LIHEAP)"],"layer":"documented","quote":"An Uninsured Patient demonstrating eligibility under one or more of the following programs shall be deemed eligible for Free Care, and will not be required to provide additional supporting documentation for such Financial Assistance: A. Homelessness B. Deceased with no estate C. Mental incapacitation with no one to act on Patient's behalf D. Medicaid eligibility, but not on date of service or for non-covered service E. Enrollment in the following assistance programs for low-income individuals having eligibility criteria at or below 250% of the then current Federal Poverty Income guidelines: 1. Women, Infants and Children Nutrition Program (WIC) 2. Supplemental Nutrition Assistance Program (SNAP) 3. Illinois Free Lunch and Breakfast Program 4. Low Income Home Energy Assistance Program (LIHEAP)","source_id":"fap-8a852ef2e6b5a7fd","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["photo_id","proof_of_income","tax_return","pay_stubs","proof_of_residency"],"layer":"documented","quote":"Verification of Illinois Residency: • At least one of the following documents: M A copy of a valid state-issued identification card M Recent residential utility bill with Illinois address M A copy of your Illinois voter registration card M Mail addressed to your current address from a government or other credible source M Letter from homeless shelter, transitional house or other similar facility verifying that you live at the facility M A copy of your Illinois vehicle registration card M A temporary visitor’s driver’s license M Lease agreement M A statement from a family member who resides at the same address and presents verification of residency M One of the documents listed in the “Financial Documents” section below Financial Documents: • At least one of the following documents: M A copy of your most recent tax return M A copy of your most recent W-2 and 1099 forms M Copies of your two most recent employer checks or pay stubs M Copies of your two most recent unemployment checks or pay stubs M Written income verification from an employer if paid in cash","source_id":"application-21deced53a561dd0","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Application Period: The period during which an NMHC Hospital Affiliate must accept and process an Application submitted by an individual in order to have made reasonable efforts to determine whether the individual is eligible for Financial Assistance. With respect to any care provided by an NMHC Hospital Affiliate to an individual, the Application Period begins on the date the care is provided to the individual and ends on the 240th day after the date the NMHC Hospital Affiliate provides (i.e. mails, sends electronically, or delivers by hand) the individual with the first post-discharge billing statement for the care.","source_id":"fap-8a852ef2e6b5a7fd","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":null,"hours":null,"languages":null},"coverage":{"facilities":{"value":["Northwestern Memorial Hospital","Northwestern Medicine Lake Forest Hospital","Northwestern Medicine Central DuPage Hospital","Northwestern Medicine Delnor Hospital","Kishwaukee Hospital","Valley West Hospital","Northwestern Medicine - Ben Gordon Center","Marianjoy Rehabilitation","NM Huntley, NM McHenry and NM Woodstock Hospitals","Palos Community Hospital"],"layer":"documented","quote":"A. Hospital Affiliates 1. Northwestern Memorial Hospital 2. Northwestern Medicine Lake Forest Hospital 3. Northwestern Medicine Central DuPage Hospital 4. Northwestern Medicine Delnor Hospital 5. Kishwaukee Hospital 6. Valley West Hospital 7. Northwestern Medicine - Ben Gordon Center 8. Marianjoy Rehabilitation 9. NM Huntley, NM McHenry and NM Woodstock Hospitals 10. Palos Community Hospital","source_id":"fap-8a852ef2e6b5a7fd","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-8a852ef2e6b5a7fd","kind":"hospital_web","url":"https://www.nm.org/-/media/northwestern/resources/patients-and-visitors/billing-and-insurance/financial-assistance/english/nmhc-financial-assistance-policy.pdf","title":"NMHC Financial Assistance Policy","fetched_on":"2026-10-14","sha256":"8a852ef2e6b5a7fd7211487e9b775557f0529972701839cce23f184e71d812ad","effective_date":null},{"id":"application-21deced53a561dd0","kind":"hospital_web","url":"https://www.nm.org/-/media/northwestern/resources/patients-and-visitors/billing-and-insurance/financial-assistance/english/northwestern-medicine-financial-assistance-application-fillable.pdf","title":"FINANCIAL ASSISTANCE APPLICATION","fetched_on":"2026-10-14","sha256":"21deced53a561dd0bdb464f71006a66b3c1e11d4ccb571999668e99061330e47","effective_date":null},{"id":"summary-e33078296d1aaa8a","kind":"hospital_web","url":"https://www.nm.org/-/media/northwestern/resources/patients-and-visitors/billing-and-insurance/financial-assistance/english/financial-assistance-plain-language-english.pdf","title":"Financial Assistance Plain Language Summary","fetched_on":"2026-10-14","sha256":"e33078296d1aaa8a5549a146faf29c56c120459cb474219a3906df784f529bfb","effective_date":null},{"id":"billing-5d20a5e32cc3b670","kind":"hospital_web","url":"https://www.nm.org/patients-and-visitors/billing-and-insurance/help-for-those-without-insurance","title":"Help For Those Without Insurance | Northwestern Medicine","fetched_on":"2026-10-14","sha256":"5d20a5e32cc3b67011ab83bf2c7b9a7451b98418cc1281b6a2a8fd13294a8649","effective_date":null},{"id":"billing-1f240c28e2469356","kind":"hospital_web","url":"https://www.nm.org/patients-and-visitors/billing-and-insurance/financial-assistance","title":"nm.org/financialassistance","fetched_on":"2026-10-14","sha256":"1f240c28e24693560999f3a3b28c34e54ce2d32946f438d889d15fecbb54cce7","effective_date":null}],"accuracy":null}