Good Samaritan Hospital is committed to providing care to patients regardless of their ability to pay. We will assist you and provide you with information on state and federal resource programs. In addition, Good Samaritan Hospital has a financial assistance program. Qualifying for our program or state/federal programs is based on income guidelines and we will work with you and assist in the application process. For more information about financial assistance, you may ask during admissions, speak with a representative at the Patient Financial Services office near our main lobby or dial 7531 from any hospital phone. If you’re calling from home, a Patient Financial Services representative can be reached at (308) 236-9864 or 1-866-956-3775.
Financial Assistance for Those Unable to Pay the Full Cost of Care
Good Samaritan Hospital is a part of Catholic Health Initiatives (CHI), a nonprofit health organization with a longstanding commitment to assist those who seek our care, regardless of ability to pay.
If you are unable to pay for all or part of the care you receive from our hospital, you may be eligible for free or discounted services. Please read the information below to understand:
- How eligibility for financial assistance is determined
- How to apply for financial assistance.
This information is a summary of the national CHI policy. Please click here to read the policy in full.
Please Note: Any patient seeking emergency care will be treated without regard to ability to pay.
How eligibility for financial assistance is determined
To determine your eligibility for financial assistance, we consider:
The medical necessity of services received. In short, medically necessary services save your life, make you well, or prevent a medical condition from becoming worse. There is a detailed definition of medically necessary services in the CHI policy.
Medical necessity will be determined by a physician. In determining medical necessity, we follow all requirements of the federal Emergency Medical Treatment and Active Labor Act and applicable laws and regulations.
Your ability to pay for the services. We look at income, family size, available resources and expected future income (minus living expenses).
You may qualify for 100% of your care provided for free, or a discounted charge under one or both of these criteria:
Your family income is low. Free care may be available to patients with family income less than or equal to 130 percent of the Department of Housing and Urban Development (HUD)very low income guidelines for the area; and/or
You are considered medically indigent. This means that paying the full cost of your medical care, after any health insurance payment, would cause you to become impoverished. This could apply if you are uninsured, underinsured, or suffer a catastrophic illness.
How to apply for financial assistance
When you are registered as a patient, we will ask about your coverage for health care services. If you don’t have coverage or it is not likely to be sufficient, we will either give you a packet of information that covers our financial assistance policy or offer the immediate assistance of a financial counselor, who will go over the financial assistance application with you.
You will need to complete the Financial Assistance Application form, provide all information it requests, and submit it to us.
If it is determined you are eligible for assistance, we will notify you and let you know how much assistance is available. If it is determined you are not eligible for assistance, we will let you know that in writing and give a brief explanation of the reason.
It’s important to note that if you do not have insurance, you will not be charged more for services than the amount generally billed to those who have insurance.
Once again, this is a summary of the CHI national financial assistance policy. You can read the full policy here.
If you have any questions about qualifying or applying for financial assistance, please contact firstname.lastname@example.org.