Applying
for financial help through the Compassionate Care Program
Sisters of Mercy Urgent Care strives to provide high-quality,
affordable healthcare to everyone in the communities we serve.
As part of this mission, we've established the Compassionate
Care Program to assist those who may not have enough money
to pay for services. To determine your eligibility for this
program, please complete the PDF application
below and bring it and any supporting documents to any Sisters of
Mercy Urgent Care
location.
If you are unable to print the documents, you may pick up an
application at any Sisters of Mercy Urgent Care
center.
Through
the Compassionate Care Program, you pay a nominal fee of
$10, $20, or $35 based on income level, at the time of service.
Upon submitting your Compassionate
Care application and supporting
documents, we'll determine the percentage of your bill covered
by the program and notify you of your remaining balance.
Compassionate
Care Application Guidelines
- Income
information must be provided for all income-producing family
members in the immediate household.
- Please
provide proof of income using W2 forms, tax returns or current
payroll stubs.
- Submitting
an application does not guarantee that assistance will be
granted.
- Submit
a separate application for financial aid for each new visit.
Approval for one visit does not guarantee aid for future
visits.
Sisters
of Mercy Urgent Care will:
-
Notify
all applicants regarding the status of their Compassionate
Care application.
Who
is responsible for your bill?
The patient (or requesting adult, if the patient is a minor)
is financially responsible for the cost of any healthcare services
provided by Sisters of Mercy Urgent Care. Payment for all services
provided is due at the time of service unless prior arrangements
have been made. Sisters of Mercy Urgent Care is not a free
clinic.
Bills
may be paid by:
- Cash
- Check
- Debit card
- Credit card
Questions?
The Sisters of Mercy staff are happy to answer any questions
you may have about the Compassionate Care Program. We may
also be able to refer you to other agencies that provide
financial assistance for healthcare. Please call us at
828-252-8957, Option 7.
Applications
In order to view and print these applications, you must have
Adobe Reader installed on your computer. Click
here to download
it for free.
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