Financial Assistance Application Instructions
Genesis Health System’s mission is to provide Quality, Compassionate care to all of those in need. Staying true to this mission, Genesis provides a Financial Assistance program to all of those in need in a fair non-discriminatory manner. Funds are set aside annually to assist those patients who indicate financial need. This application does not guarantee financial assistance, but begins the review process for consideration. In order to continue to provide that care, Genesis must maintain fiscal responsibility.
The Illinois Hospital Uninsured Patient Discount Act became effective 4/1/2009. Genesis Health System-Illini Campus offers uninsured Illinois residents additional financial discounts. Please contact a customer service representative for more information about uninsured Illinois resident discounts. Customer Service representatives can be reached at 563-421-3408 or 800-250-6020.
Financial Assistance Application Instructions:
- Complete the application and attach only copies of documents requested, originals will not be returned.
- Genesis Health System requests copies of several items, this is requested for all responsible parties living in the household, if any portion is refused this could result in a denial.
- Responsible parties receiving any help from anyone in regard to living expenses must include a written statement from that party.
- Once application along with requested information is received, notification will be made to the responsible party as soon as possible. If there is a request for more information needed that request will be made as soon as possible from the time the original information has been received.
- We will assist in filing for a medical card through the State Department of Human Services to ensure complete Healthcare coverage.
- Return a completed application within 30 days to:
Genesis Medical Center
ATTN: PFS / W. #2600-FA
1227 E. Rusholme Street
Davenport, IA 52803
Financial Assistance will not be granted in the following situations:
- Any portion of an account balance payable or expected to be payable by a third party will not qualify for financial assistance.
- Fraudulent information given at any time during the process will not qualify for financial assistance. Examples include but are not limited to giving fraudulent name, address, employer/employment, income, and assets. Also included is if there is a change in financial position after financial assistance has been given and the hospital/facility is not notified of this change in position.
Genesis Medical Center Financial Assistance application.