Assistance & Applications
Qualified patients may apply for financial assistance. The hospital will ask for information about your income and ask you to complete and sign a short form. Eligibility is determined by reviewing and verifying family income and size. If you would like additional information about this program, please contact the business office or you may download the attached file (click on Financial Assistance Application below), complete and sign the form and return it to our offices.
Rochelle Community Hospital has contracted with an outside vendor to better serve our patients in resolving their self-pay balances. Monthly statements and telephone calls may be received from our billing and collection agency. They are committed to assisting our patients to the same extent as our in-house staff personnel are. If you have any questions about the invoices or telephone calls you receive on our behalf, you may contact the number on your statement or our business office for clarity.
- Plain Language Financial Assistance/Collection Policy Summary – English
- Plain Language Financial Assistance/Collection Policy Summary – Spanish
- Financial Assistance Cover Letter – English
- Financial Assistance Cover Letter – Spanish
- Financial Assistance Application – English
- Financial Assistance Application – Spanish
- Guidelines for Charity Care-Financial Assistance Program – English 01-2021
- Guidelines for Charity Care-Financial Assistance Program – Spanish 01-2021