Patients & Visitors
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
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
Español. You may also view a copy of the complete financial assistance policy in
In order to qualify for financial assistance, you must:
Complete a financial assistance application form available in
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
- 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
- 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.
If you have any questions about IVCH Financial Assistance or need assistance
completing the application, please contact our Patient Financial Services
815.780.3418. If available, please contact the phone number listed on your billing
Print the desired form, complete it, and then bring or mail it with appropriate
Attention: Patient Financial Services
925 West St.
Peru, IL 61354