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Plain Language Summary

Phelps Health Plain Language Summary - Financial Assistance/Charity Care

Phelps Health will provide medically necessary services to all patients without regard to the patient’s financial ability to pay. If you are unable to pay your bill, please contact us at (573) 458-7715 to see if you are eligible to receive financial assistance. You may be eligible for full or partial financial assistance if your household income is at or below 225% of the federal poverty level.

A patient’s/family's/guarantor’s gross income, net worth, assets, household size and life/job changes are taken into consideration in determining what financial assistance is given based on the Federal Poverty Guidelines. Patients need to furnish a copy of their most recent Federal Tax Return (1040) with all schedules and copies of their last three payroll check stubs (for all employers) for all people working in the family and proof of any other income (e.g., public assistance, unemployment benefits, workers' compensation, alimony, child support, rental and business income, royalties, etc.). Self-employed patients/guarantors are required to furnish their latest year-to-date income and expense figures.

Financial assistance/charity care is provided to eligible Missouri residents who are United States citizens or married to a US citizen who reside in our primary service area/counties (Phelps, Dent, Texas, Pulaski, Maries, Crawford, Osage, Gasconade, Laclede, Camden and Miller) and do not have the ability to pay. College students' residency will be determined by the taxes of the person who claimed them as an exemption on the most recent completed tax year. The patient may be uninsured or underinsured to be considered for financial assistance. Elective procedures are exempt from financial assistance.

Phelps Health provides financial assistance to patients meeting the eligibility criteria outlined in the Financial Assistance Policy. After the patient’s account(s) is reduced by the financial assistance adjustment based on policy, the patient is responsible for the remainder of his or her outstanding patient account, which shall be no more than the amount generally billed (AGB) to individuals who have Medicare Fee-for-Service and private health insurers for emergency and other medically necessary care.

How to Apply for Financial Assistance

If you would like to apply for financial assistance, you can call (573) 458-7715 and ask for a financial assistance packet to be sent to you or a packet can be picked up at the Phelps Health cashier’s office (Monday-Friday, 8:00 AM-4:30 PM) located near the Main Entrance of Phelps Health Hospital, 1000 West 10th Street, Rolla, MO, or you can print a packet.

Download or Print Financial Assistance Application Packet

Please follow the instructions and provide copies of all the requested information. Original documentation, such as tax information, cannot be mailed back to the patient. You also can attach a written explanation of any recent changes to your situation that you feel would be pertinent. If you have questions or need help with the financial assistance application, please call (573) 458-7715.


financial assistance, charity care, apply for help