FINANCIAL ASSISTANCE

How It Works 

JCHC is able to provide eligible patients with discounted medical care through its Financial Assistance Program.  In order to qualify, a patient/patient’s family must be current Iowa resident(s) and must fall within the Federal Poverty guideline requirements.  Based on family size and where the household income lies, a discount of 10% - 100% could be applied to Hospital accounts.  

SIZE OF FAMILY UNIT

100%

CHARITY

90%

CHARITY

60%

CHARITY

40%

CHARITY

20%

CHARITY

10%

CHARITY

0%

CHARITY

1

$12,760

$19,140

$25,520

$31,900

$38,280

$44,660

>$44,660

2

$17,240

$25,860

$34,480

$43,100

$51,720

$60,340

>$60,340

3

$21,720

$32,580

$43,440

$54,300

$65,160

$76,020

>$76,020

4

$26,200

$39,300

$52,400

$65,500

$78,600

$91,700

>$91,700

5

$30,680

$46,020

$61,360

$76,700

$92,040

$107,380

>$107,380

6

$35,160

$52,740

$70,320

$87,900

$105,480

$123,060

>$123,060

7

$39,640

$59,460

$79,280

$99,100

$118, 920

$138,740

>$138,740

8

$44,120

$66,180

$88,240

$110,300

$132,360

$154,420

>$154,420

 

For each additional person

$4,480

$6,630

$8,840

$11,050

$13,260

$15,470

>$17,680


Once a patient qualifies for JCHC’s Financial Assistance, the application and approval percentage will be good for (6) months, at which time the approval will expire and a patient would need to resubmit an application to see if the financial situation has changed.

Please Note: Services performed by non-JCHC consultants (Specialty Clinics), Radiology Consultants of Iowa, Collaborative Lab Services, Midwest Ambulance, or any other third-party affiliate not billed through JCHC will not be considered for Financial Assistance.
Additionally, previously discounted Hospital services, charges, and/or accounts will not receive additional discounting through Financial Assistance.

Requirements for Financial Assistance

In addition to meeting Federal Poverty guidelines and being a current Iowa resident, the following items are required:

  1. Completed and signed application.
  2. Proof of Income (current source from any of the following: pay stubs, tax return/W-2, self-employment worksheet, bank statement indicating monthly deposit, etc.)

Financial Assistance Information

Financial Assistance Application

Please return the completed application and required documentation to:

1. Mailing Address:
Attn: Financial Counselor
2000 S. Main
Fairfield, IA 52556

2. Fax: (641) 469-4216, Attn: Financial Counselor

3. Email: billing@jeffersoncountyhealthcenter.org, Attn: Financial Counselor

4. Drop off in person! 

Questions? Please feel free to call our Financial Counselor at (641) 469-4311 or our Billing Office at (641) 469-4301.

Additional Online Resources

Charge Master

Jefferson County Health Center (JCHC) believes you have the right to understand your healthcare options and the cost of care. This information is published from the Hospital’s (JCHC's) charge master and does not reflect rates negotiated by health insurance or provider networks or discounts a patient may receive as a result of our financial assistance policy.  If you are covered by health insurance, we encourage you to contact your health insurance provider to determine accurate information about your financial responsibility for a particular health care service provided at this facility. If you are not covered by health insurance, you are strongly encouraged to contact our Financial Counselor at 641-469-4311 to discuss payment options prior to receiving services from JCHC, as posted prices do not necessarily reflect your personal financial responsibility or the cost of the service at the time you receive the service.  In addition, services billed by other providers, such as services billed by physicians or third party vendors are not included.  Drug prices subject to change based on manufacturer/product in stock as well as cost of those medications which update regularly.

JCHC Drug Charges 12-20-18

JCHC Professional CDM 07-01-19

JCHC Technical CDM 07-01-19