# St. Marys Hospital Medical Ctr

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

St. Marys Hospital Medical Ctr 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)
- 200.1% to 300% of poverty level, patient pays 10% of the bill (90% discount)
- 300.1% to 400% 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.

## 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 25% of income yearly cap, while the policy itself says 20%. Ask the business office which applies. The local business office for this hospital is 920-498-4200.

## 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 400% 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 St. Mary’s Hospital Medical Center – Green Bay
- Local business office phone https://hshs.ellucid.com/documents/view/22255/?security=d585b615bcd5146064959c161752e9985ce39ed9
  > Phone: 920-498-4200

Last checked 2026-11-11.

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