# HSHS Good Shepherd Hospital Inc

Hospital in Shelbyville, IL. Verified from the hospital's own policy.

HSHS Good Shepherd Hospital Inc 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 $95,760 for 1 person, $129,840 for 2, $163,920 for 3, $198,000 for 4, $232,080 for 5 or $266,160 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $31,920 | $95,760 |
| 2 | $43,280 | $129,840 |
| 3 | $54,640 | $163,920 |
| 4 | $66,000 | $198,000 |
| 5 | $77,360 | $232,080 |
| 6 | $88,720 | $266,160 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 200% of poverty level, patient pays nothing (100% discount)
- 200.1% to 300% of poverty level, patient pays 10% of the bill (90% discount)
- 300.1% to 600% of poverty level, patient pays 20% of the bill (80% discount)

## How to apply

- Call 833-464-1778 and ask for financial assistance.
- [Application form](https://www.hshs.org/getmedia/fc8fc549-210b-4285-8e5b-e627fb99b644/HSHS-FA-Application-EN.pdf)
- [Financial Assistance Program Policy](https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9)
- [Plain language summary](https://www.hshs.org/getmedia/70166836-f265-459e-a377-d563c123c1b5/HSHS-Financial-Assistance-Brochure-%28ENG%29.pdf)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring completed application, proof of income (pay stubs, tax return or W-2, or benefit letter), one month of bank statements for each account, statement of assets, proof of residency (state ID or driver's license, or utility bill).
- Savings and property. The policy counts savings or property, not only income.
- Very large bills. Medical debt above 20% of yearly family income can be written off, if the patient tells HSHS and it is verified
- Languages. English, Spanish, Hmong

## 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 other medically necessary care at HSHS hospitals, including balances left after insurance pays.

Not covered. Elective, cosmetic and other care that insurance usually does not pay for. Doctors who are not HSHS doctors may bill separately and may not follow this policy. HSHS posts a list of providers who do and do not honor the policy on hshs.org.

## State program in Illinois

### Hospital Uninsured Patient Discount Act (210 ILCS 89), rural and Critical Access Hospitals

Illinois law sets lower levels for Critical Access Hospitals and hospitals outside metro areas. If you are an uninsured Illinois resident and your family income is at or below 125% of the federal poverty level, you may qualify for a free bill for care over $300 per visit or stay. If your income is at or below 300%, you may qualify for a discount. The bill is cut to about 135% of what the care cost the hospital. For people who get the discount, the most a hospital can collect in 12 months is 20% of family income. This state law covers uninsured patients only. If you have insurance, the hospital's own policy may still help. Many hospitals offer more than the law requires, so check the hospital's own policy too. You must apply. The hospital decides.

Income levels in the program are free up to 125%, discount up to 300% of poverty level.

Applies to Illinois Critical Access Hospitals and licensed hospitals outside a metropolitan statistical area; uninsured Illinois residents only.

How to apply. Ask the hospital's financial counseling or billing office for its financial assistance application. Apply within 90 days of discharge, the date of service, the hospital's screening, or a denial of Medicaid or other public coverage. The hospital may ask for proof of income (a tax return, W-2, two recent pay stubs, or an employer letter) and proof that you live in Illinois. If you have a problem, call the Illinois Attorney General's Health Care Hotline at 1-877-305-5145.

> A rural hospital or Critical Access Hospital shall provide a charitable discount of 100% of its charges

Source https://ftp.ilga.gov/ILCS/Ch%200210/Act%200089/021000890K10.html, checked 2026-11-11

## Notes

HSHS uses one policy for all its hospitals, with different top income limits in Illinois and Wisconsin. Significant assets, worth more than 6 times the poverty level, generally make a patient ineligible. People enrolled in programs like SNAP, WIC, TANF or LIHEAP may be approved for a full write-off without income proof. Patients may be asked to apply for Medicaid or other programs first. A denial can be appealed within 30 days. The 2026 plain language brochure lists a top discount level of 400% and a 25% of income yearly cap, which does not match the Illinois terms in the policy itself. Ask the business office which applies. The local business office for this hospital is 217-774-3961. Uninsured patients at Illinois HSHS hospitals get a 72% uninsured discount automatically, which may vary by location.

## Sources

- Free care level https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Below 200% of FPL are eligible to receive a 100% discount.
- Discount level https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Above 300% of FPL but equal to or less than 600% are eligible to receive an 80% discount.
- Discount steps https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Above 200% of FPL but equal to or less than 300% are eligible to receive a 90% discount.
- Insured patients https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Financial assistance will be extended to uninsured and underinsured patients, or a patient’s guarantor, who meet specified criteria
- Asset test https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Available assets of patients will be considered in determining eligibility for financial assistance under the Financial Assistance Program.
- Very large bills https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Catastrophic medical debt is defined as medical debt more than 20% of the annual income of the patient’s family.
- Deadline https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > ends on the later of the 240th day after the date the first post-discharge statement for the care is provided
- Documents https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Checking/Savings = 1 month of complete (all pages) bank statement for each account.
- Financial counseling phone https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Toll Free – (833) 464-1778
- Covered facility https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > HSHS Good Shepherd Hospital – Shelbyville
- Local business office phone https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Phone: 217-774-3961

Last checked 2026-11-11.

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