CHI Health Bergan Mercy

Nonprofit acute care hospital in Omaha, NE.

Verified from the hospital's own policy

CHI Health Bergan Mercy likely gives free care to households with a yearly income up to $31,920 for 1 person, $43,280 for 2, $54,640 for 3, $66,000 for 4, $77,360 for 5 or $88,720 for 6. It likely gives a discount to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6.

The hospital makes the final decision.

Discount steps

• 0% to 200% of poverty level, you pay nothing (up to 100% discount)
• 201% to 400% of poverty level, you pay no more than the hospital's Amount Generally Billed (AGB); policy says income must be lower than 400%

How to apply

1. Call 866-881-0293 and ask for financial assistance.
2. Application form
3. Financial Assistance Policy (CommonSpirit Governance Policy Finance G-003, effective July 1, 2026)
4. Plain language summary
5. Bring completed Financial Assistance Application, proof of income (tax return, W-2, 3 months of pay stubs, or a signed letter), bank statements for the last 3 months and other asset information, Medicaid approval or denial, if applied, signed statement explaining how you pay basic living costs, if you have no income.
6. The policy gives 365 days to apply. Ask the billing office which date the count starts from.

Residency

Must live in the hospital's service area, unless the visit is urgent or emergency care. Scheduled care for people outside the area needs the hospital CFO's approval.

Savings and property

The policy counts savings or property, not only income.

Languages

English, Spanish, Arabic, German, French, Hindi, Hmong, Japanese, Korean, Portuguese, Russian, Tagalog, Vietnamese, Simplified Chinese, Traditional Chinese

If you have insurance

Insured patients can also apply for help with deductibles and copays. Keep your insurance. Financial assistance covers bills from this one place only.

What is covered

Covered

Emergency and medically necessary care at the hospital, including care from doctors and clinicians the hospital employs. Also non-covered medically necessary care, such as days past an insurance length-of-stay limit.

Not covered

Elective and cosmetic care is not covered. Doctors and other providers who are not employed by CHI Health may bill separately and may not follow this policy. Check the hospital's list of providers not covered.

Notes

Income up to 200% of the poverty level may get the full bill forgiven. Income from 201% up to just under 400% may have the bill cut to the amount insurers generally pay. People with insurance can apply for help with what they still owe. The hospital looks at bank accounts and other assets, but not retirement accounts. You may need to apply for Medicaid first. Approval covers bills from the past 12 months and care for the next 6 months. The hospital decides within 30 days of a complete application, and a denial can be appealed by calling 866-881-0293. Some people get help without applying, for example people on food stamps, WIC or Medicaid, or who are homeless. Mail applications to CommonSpirit Health Financial Assistance, PO Box 5096, Fredericksburg, VA 22403, or fax 1-269-202-5498. Uninsured patients who do not qualify may still get a self-pay discount.

Sources

• Free care level

  Any patient whose Family Income is at or below 200% of the FPL ... is eligible to receive Financial Assistance up to a 100% discount

• Discount level

  Any patient whose Family Income is at or above 201% but lower than 400% of the FPL

• Discount steps

  reducing his or her account balance for eligible services ... to an amount no more than the Hospital Facility's AGB.

• Insured patients

  Financial Assistance is offered to insured patients to the extent allowed under the patient's insurance carrier contract.

• Asset test

  the patient must provide bank or checking account statements evidencing the patient's available resources

• Residency

  have established residency within the CommonSpirit Entity Service Area as defined by the most recent Hospital Facility CHNA, unless the visit is urgent or emergent

• Deadline

  It expires on the later of (i) 365 days from the patient's discharge from the Hospital Facility or the date of the patient's EMCare

• Documents

  REMEMBER: You must include proof of income with your application.

• Financial counseling phone

  Call the financial counselor of the Hospital Facility at: 866-881-0293

• Covered facility

  Providers Covered by our Financial Assistance Policy ... CHI Health Creighton University Medial Center- Bergan Mercy & Lasting Hope Recovery Center

Last checked. 2026-11-11