Patients and Visitors

Patient Financial Assistance

Patient Financial Assistance Application

Financial Assistance and Prompt Pay Policy

In support of the mission of the Sisters of Mercy to provide for the sick and the vulnerable, Mercy Hospital Iowa City administers a program through Patient Financial Services to assist patients by reducing or forgiving the cost of necessary healthcare services provided by Mercy Hospital Iowa City based on financial need, both indigent and catastrophic. A financial assistance application must be filled out and returned within 240 days of first billing statement to be considered for financial assistance. Applications are available here, at the hospital, or can be mailed or faxed to patient guarantor upon request. Financial assistance is provided to patients meeting guidelines after all other means of funding (including personal income and assets which could be sold), Medicaid, Medicare, Insurance Exchange, or other support networks are exhausted.

Assistance is determined using hospital defined Financial Assistance Guidelines based on the current year Federal Poverty Level guidelines (FPL). Applicants with household income less than or equal to 300% of FPL qualify for financial assistance and are responsible for no more than 35% (AGB from previous fiscal year) of billed charges. Applicants with household income less than or equal to 200% of FPL qualify for 100% assistance. An additional 5% catastrophic discount from charges is available when patient responsibility for a single claim greater than or equal to $25,000.

Extended, interest free, payment plans are also available for those qualifying for financial assistance. Extenuating circumstances, (including but not limited to: other medical bills, change in employment, disabilities, death) are considered with all applications.

For those patients without insurance and do not qualify for financial assistance a prompt pay discount is available. Mercy Hospital offers a 30% discount from charges if the patient’s balance is paid in full within 45 days of first billing statement, 20% if paid in full within 90 days, and 10% if paid in full within 6 months. Twelve month interest free payment plans are available to all patients. Payment plans must be at $50/month and be paid in fill within 12 months unless other arrangements are agreed to by a member of Mercy management.

Evaluations of Mercy Hospital financial assistance applications are typically processed within two weeks of receipt.