# OSF Saint Katharine Medical Center

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

OSF Saint Katharine Medical Center likely gives free care to households with a yearly income up to $39,900 for 1 person, $54,100 for 2, $68,300 for 3, $82,500 for 4, $96,700 for 5 or $110,900 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.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $39,900 | $63,840 |
| 2 | $54,100 | $86,560 |
| 3 | $68,300 | $109,280 |
| 4 | $82,500 | $132,000 |
| 5 | $96,700 | $154,720 |
| 6 | $110,900 | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 250% of poverty level, patient pays nothing (100% discount on the patient balance)
- 250.1% to 300% of poverty level, patient pays 25% of the patient balance (75% discount)
- 300.1% to 350% of poverty level, patient pays 50% of the patient balance (50% discount)
- 350.1% to 400% of poverty level, patient pays 75% of the patient balance (25% discount)
- 400.1% to 600% of poverty level, patient pays uninsured patients only: the more generous of the uninsured discount or a cost-based price (135% of cost-to-charge ratio)

## How to apply

- Call (800) 421-5700 and ask for financial assistance.
- [Application form](https://osf-p-001.sitecorecontenthub.cloud/api/public/content/57118e85e1f8428a976cbb73fe254b8e?v=d75f5ab3)
- [Financial Assistance (AC-29), effective 7/27/2026](https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/)
- [Plain language summary](https://osf-p-001.sitecorecontenthub.cloud/api/public/content/55437bb7863748409b90fcea2be2852f?v=30303d27)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring one proof of income (recent federal tax return, W-2 or 1099, two recent pay stubs, proof of other income, or bank statements), asset and expense information (collected under Illinois law), Medicaid application or a Medicaid denial from the last 6 months, if likely eligible for Medicaid.
- Residency. None. Open to patients regardless of where they live or immigration status
- Very large bills. OSF charges capped at 25% of family income for patients with high medical cost obligations
- Languages. English, Spanish, French, Polish

## 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 care, care for life-threatening conditions, and other medically necessary care billed by OSF.

Not covered. Elective care that is not medically necessary, such as cosmetic surgery, Lasik, fertility, dental, glasses and hearing aids. Care billed by non-OSF doctors or ambulance services. Out-of-network care for insured patients is reviewed case by case.

## 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

OSF uses one financial assistance policy for its hospitals in Illinois and Michigan. Patients without insurance also get an automatic uninsured discount off full charges, whatever their income. Patients with insurance can apply for help with what they still owe. People with an HSA or FSA are expected to use it first. People likely to qualify for Medicaid may be asked to apply for Medicaid first. Approval lasts 12 months and also covers unpaid bills from the application period. OSF decides within 30 days of a complete application, and a denial can be appealed in writing within 30 days. Interest-free payment plans are available. Uninsured patients can also get free help from Elevate PFS at (866) 402-3630. The policy says asset and expense information is collected, but it does not say assets can cause a denial, so asset_test is left unknown.

## Sources

- Free care level https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > Family Income up to 250% FPL are eligible to receive a 100% discount on the Patient Balance Due
- Discount level https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > Family Income of above 350% FPL but equal to or less than 400% FPL are eligible to receive a 25% discount
- Discount steps https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > For Uninsured Patients with Family Income equal to or less than 600% of the Federal Poverty Level, OSF has compared the discounts scheduled above
- Insured patients https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > Financial Assistance will be extended to Uninsured and Underinsured Patients, or such Patient's Guarantor, who receive Eligible Services
- Residency https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > available to all Patients meeting the requirements set forth in this policy, regardless of geographic location or immigration status.
- Very large bills https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > will have their OSF charges discounted to an amount not to exceed 25% of Family Income.
- Deadline https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > Applications for Financial Assistance may be submitted up to 240 days after the date of the first post discharge statement.
- Documents https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > Per the IL Fair Patient Billing Act, 77 I.A.C. 4500.30, OSF is required to collect asset and expense information
- Financial counseling phone https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > If you need help in completing the Financial Assistance application, you may call (800) 421-5700 to speak with a financial navigator.
- Languages https://osf-p-001.sitecorecontenthub.cloud/api/public/content/55437bb7863748409b90fcea2be2852f?v=30303d27
  > Translation of these documents can be found on the website or upon request.
- Covered facility https://osf-lcmmc.policystat.com/policy/token_access/65a974f7-7575-405e-b730-45d6f6c16368/
  > The hospitals covered by this policy are: ... OSF Saint Katharine Medical Center

Last checked 2026-11-11.

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