Financial Assistance

MercyOne Genesis provides a Financial Assistance program to all of those in need in a fair non-discriminatory manner. MercyOne Genesis offers a Financial Assistance Program that may provide a sliding fee schedule for patients whose annual household income is within 200% of the federal poverty guideline and owe a balance after insurance pays. For example, a family of four with an annual household income of $63,600 or less may be eligible for a 50% discount on the account balance after insurance payments have been applied.

Financial Assistance Application Instructions

This application does not guarantee financial assistance, but begins the review process for consideration. In order to continue to provide that care, MercyOne Genesis must maintain fiscal responsibility.

The Illinois Hospital Uninsured Patient Discount Act became effective 4/1/2009. MercyOne Genesis Silvis Medical Center 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:

1. Complete the application and attach only copies of documents requested, originals will not be returned.
2. MercyOne Genesis 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.
3. Responsible parties receiving any help from anyone in regard to living expenses must include a written statement from that party.
4. 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.
5. We will assist in filing for a medical card through the State Department of Human Services to ensure complete Healthcare coverage.
6. Return a completed application within 30 days to:

MercyOne Genesis Medical Center
ATTN: PFS / W. #2600-FA
1227 E. Rusholme Street
Davenport, IA 52803

Or if in Aledo, please send FA applications to:

MercyOne Genesis Aledo Medical Center
409 NW 9th Avenue
Aledo, IL 61231
(309) 582-9275

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.