Financial Assistance Policy Summary
Who can apply?
- Uninsured patients
- Underinsured patients
- Patients who are ineligible for government programs
- Patients who can’t pay for medically necessary care or emergency
care because of their financial situations
How to apply
- Complete and sign the Financial Assistance Application on the other side.
Complete application on our website:
- Provide the additional information requested.
Who is eligible?
Financial assistance may be granted for 25 percent, 50 percent, 75 percent
or 100 percent of the patient’s bill. Eligibility is based on applicants’
total household income. The amount of assistance granted is based on Federal
Poverty Levels of the Federal Poverty Guidelines, which are updated annually.
The Financial Assistance Committee may consider requests for assistance
from patients whose incomes exceed eligibility criteria. Patients who
are eligible for financial assistance will not be charged an amount greater
than the amount generally billed by Medicare, Medicaid and commercial
Great River Medical Center offers financial assistance to pay for emergency,
trauma and other medically necessary services:
- All inpatient
- Day Hospital
- Diagnostic imaging
- Digestive health
- Heart and vascular
- Wound clinic
Possible eligible services
Eligibility for these services is not guaranteed, but services can be evaluated
individually by the Financial Assistance Committee:
- Cosmetic services
- Elective services
- Home health and hospice
- Skilled nursing facility and residential long-term care (Klein Center)
Other important information
- Financial assistance will be applied to all open balances with dates up
to three months before the date the Financial Assistance Application was signed.
- Assistance will include balances up to 12 months from the date of the signed
application if the responsible party continues to meet eligibility requirements.
Income will be re-evaluated every three months.
- Patient payments of more than $5 that were received up to three months
before the date of the financial assistance application will be refunded
to the patient up to the amount of the eligibility determination.
For more information or to request a copy of the complete Financial Assistance
Policy and Charity Care Matrix, please visit or call Patient Financial
Services-Patient Billing at (319) 768-3625, option 2, or toll-free (877)
404-4763, option 2. You also can see the full policy at