hospital staff and patient

Patients & Visitors

Financial Assistance

Illinois Valley Community Hospital affirms and maintains its commitment to serve our community in a manner consistent with our mission, vision and values. These emphasize our commitment to meet the health care needs of our community through the provision of high-quality patient care. Within the limits of our resources, the use of our facility's services and efforts will be provided to aid all persons, regardless of their financial resources.

Illinois Valley Community Hospital offers financial assistance for emergency and medically necessary care. This financial assistance, ranging from a reduction in the amount of the balance outstanding up to complete forgiveness of the balance outstanding, is provided to patients demonstrating financial need and billed through our Patient Financial Services department.

Illinois Valley Community Hospital has a financial assistance policy. You may view a copy of the program summary in English or Español. You may also view a copy of the complete financial assistance policy in English or Español.

In order to qualify for financial assistance, you must:

  • Complete a financial assistance application form available in English or Español. You can also obtain a copy of the application by:
    • Contacting a patient financial service representative at the phone number listed on your billing statement, or
    • Contacting Patient Financial Services at 815.780.3418, or
    • Visiting a registration representative at the hospital or clinics.
  • Provide documentation of income for the last 12 months, including any of the following: most recent federal tax form 1040, W-2 forms and 1099 forms, and the last two pay stubs for all household members.
  • Provide evidence that you have pursued all other payment sources, including public aid.
  • Provide bank statements for the last two months for all household members

Your application will be reviewed and a decision will be communicated to you within 30 days. All information is confidential. To quality for financial assistance, your household income must be at or below 300 percent of the federal policy level per income guidelines established by the U.S. Dept. of Health and Human Services.

Contact Us

If you have any questions about IVCH Financial Assistance or need assistance completing the application, please contact our Patient Financial Services Department at 815.780.3418. If available, please contact the phone number listed on your billing statement.

Print the desired form, complete it, and then bring or mail it with appropriate documentation to:

IVCH

Attention: Patient Financial Services

925 West St.

Peru, IL 61354

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