CHI ST JOSEPH HEALTH REGIONAL HOSPITAL

"Any patient whose Family Income is at or below 200% of the FPL, including, without limitation, any Uninsured or Underinsured patient, is eligible to receive Financial Assistance up to a 100% discount from his or her account balance for eligible services provided to the patient after payment, if any, by any third-party(ies)."

documented · checked 2026-10-10 · [PDF] Financial Assistance - CHI St. Joseph's Health

"In particular, presumptive eligibility may be determined on the basis of individual life circumstances that may include:  Recipient of state-funded prescription programs;  Homeless or one who received care from a homeless or free care clinic;  Participation in Women, Infants and Children programs (WIC);  Food stamp eligibility;  Eligibility or referrals for other state or local assistance programs (e.g., Medicaid);  Low income/subsidized housing is provided as a valid address; or  Patient is deceased with no known spouse or known estate"

documented · checked 2026-10-10 · [PDF] Financial Assistance - CHI St. Joseph's Health

"To qualify for assistance, patient must provide bank or checking account statements evidencing the patient’s available resources (those convertible to cash and unnecessary for the patient’s daily living) and at least one (1) piece of supporting documentation that verifies Family Income is required to be submitted along with the FAA."

documented · checked 2026-10-10 · [PDF] Financial Assistance - CHI St. Joseph's Health

"Mail or fax completed application with all documentation to: CHI St. Joseph's Health, ATTN: EES - Financial Assistance Center, P.O. Box 660872. Dallas, TX 75266-0872 Fax: 469-803-4627. Be sure to keep a copy for yourself. To submit your completed application in person: CHI St. Joseph's Health, 600 Pleasant Avenue, Park Rapids, MN 56470"

documented · checked 2026-10-10 · [PDF] CHI St. Joseph's Health Financial Assistance Application Form ...

"We will notify you of the final determination of eligibility and appeal rights, if applicable, within 30 calendar days of receiving a complete financial assistance application, including documentation of income."

documented · checked 2026-10-10 · [PDF] CHI St. Joseph's Health Financial Assistance Application Form ...