# SSM Health St. Clare Hospital - Baraboo

Hospital in Baraboo, WI. Verified from the hospital's own policy.

SSM Health St. Clare Hospital - Baraboo 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.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $31,920 | $63,840 |
| 2 | $43,280 | $86,560 |
| 3 | $54,640 | $109,280 |
| 4 | $66,000 | $132,000 |
| 5 | $77,360 | $154,720 |
| 6 | $88,720 | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 200% of poverty level, patient pays nothing (100% discount)
- 201% to 250% of poverty level, patient pays 20% of the bill (80% discount)
- 251% to 300% of poverty level, patient pays 40% of the bill (60% discount)
- 301% to 350% of poverty level, patient pays full amount up to $2,000, then 50% of the amount over $2,000
- 351% to 400% of poverty level, patient pays full amount up to $2,000, then 80% of the amount over $2,000

## How to apply

- Call 888-918-3512 and ask for financial assistance.
- [Application form](https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-financial-assistance-application.pdf)
- [Operations - Financial Assistance Policy (Charity Care)](https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf)
- [Plain language summary](https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-plain-language-summary.pdf)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring signed application, proof of income for the last two months for all household members 18 and over, most recent federal tax return with all schedules, or IRS non-filing letter, bank and savings statements for the last three months (may be requested), Medicaid approval or denial letter (if screened as possibly eligible).
- Residency. May be limited to people who live in the hospital's service area. International and traveling patients generally do not qualify, except for emergencies.
- Savings and property. The policy counts savings or property, not only income.
- Very large bills. Case-by-case help for catastrophic medical costs (medical indigence). Generally the bill is cut to no more than 25% of gross family income.
- Languages. English, Arabic, Chinese, French, German, Korean, Russian, Spanish, Tagalog, Vietnamese

## 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 SSM Health hospitals. The discount can apply to what is left after insurance pays.

Not covered. Cosmetic care, bariatric surgery and other care a doctor finds not medically necessary are not covered. Non-emergency care from an out-of-network SSM hospital may not qualify when an in-network option is nearby. Some doctors are not covered, so check the provider list.

## Notes

The same SSM Health policy covers this hospital and the rest of the system. Free care up to 200% of the poverty level, and smaller discounts up to 400%. Assets over $5,000 count as income, but a home (half the equity up to $50,000), retirement accounts and some other items are protected. Approval lasts six months. A Social Security number is not required. You may be asked to apply for Medicaid first. Uninsured patients may get an automatic discount first, and financial assistance is applied after it. Apply by mail to SSM Health, Attn Financial Assistance, PO Box 411997, St. Louis MO 63141, by fax at 314-989-6734, by email at financialaid@ssmhealth.com, or in person with a financial counselor at the hospital.

## Sources

- Free care level https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > 0% – 200% 100%
- Discount level https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > 351% - 400% 20% of amount over $2,000 Over 400% 0%
- Discount steps https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > 201% - 250% 80% 251% - 300% 60% 301% - 350% 50% of amount over $2,000
- Insured patients https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > The discount is applied to the patient's remaining liability after insurance for insured patients
- Asset test https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > Available assets in excess of $5,000, excluding the protected assets listed below, will be added to current year’s income
- Residency https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-plain-language-summary.pdf
  > Eligibility for financial assistance may be restricted to residents in the primary service areas of SSM Health’s care sites.
- Residency https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > Financial Assistance will not be available to International/Traveling patients. Exceptions may be made for emergent occurrences
- Very large bills https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > Generally, patient liability will be adjusted to no more than 25% of gross family income.
- Deadline https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > ends on the 240th day after the hospital provides the individual with the first post-discharge billing statement
- Documents https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-plain-language-summary.pdf
  > Verification of income (last two months) • Last year’s federal tax return or non-filing letter
- Languages https://www.ssmhealth.com/for-patients/financial-assistance/hospital-financial-assistance
  > Our Financial Assistance documentation is available to download in 11 languages:
- Financial counseling phone https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > Questions about the FAP may be directed to SSM Health Customer Service at 888-918-3512
- Covered facility https://www.ssmhealth.com/SSMHealth/media/Documents/patients-and-visitors/financial-assistance/english-charity-care.pdf
  > (2) SSM Health St. Clare Hospital - Baraboo

Last checked 2026-11-11.

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