Financial

 Financial Assistance for Patients

Catholic Health Initiatives (CHI) understands that paying for emergency and/or medically necessary medical care can be difficult, particularly for patients who lack health insurance. As part of our ongoing commitment to our patients, CHI works hard to help our patients address their financial responsibilities in a way that is fair and sensitive to their circumstances. We have instituted a program designed specifically to help those who find themselves in financial distress.

The Program The CHI Financial Assistance Policy (available in multiple languages) applies to uninsured/underinsured patients who come to our facilities for treatment. This policy provides financial relief to patients who qualify based on a comparison of their financial resources and/or income to Federal Poverty Guidelines. The program is designed specifically for non-elective care patients whose household financial resources and/or income are at or below 300 percent of the Federal Poverty Level.

To qualify for any assistance, uninsured/underinsured patients will be asked to complete a CHI Financial Assistance Application (available in multiple languages) which includes information relating to household income.

We are committed to working with our patients to establish an appropriate payment plan based on the amount due and the patient’s financial status.

If you have questions regarding our policy or applications(s), please contact Amanda Helgeson 701-662-9706.

 

CHI St Alexius Carrington Medical Center:

CHI St. Alexius Carrington PLS Eng

CHI St. Alexius Carrington PLS VT

CHI St. Alexius Carrington PLS DE

CHI St. Alexius Carrington PLS Spanish

CHI St. Alexius Carrington PLS ZH-CN

 

Financial Assistance signage:

Financial Assistance Signage 2016

Financial Assistance Signage 2016_DE

Financial Assistance Signage 2016_ES-US

Financial Assistance Signage 2016_VI

Financial Assistance Signage 2016_ZH-CN

 

Financial Assistance Application (15a):

No. 15a Financial Assistance Application 6-2016

No. 15a Financial Assistance Application 6-2016_DE

No. 15a Financial Assistance Application 6-2016_ES-US

No. 15a Financial Assistance Application 6-2016_VI

No. 15a Financial Assistance Application 6-2016_ZH-CN

 

Stewardship policy No 15

No 15 Financial Assistance ENGLISH 12-07-16

No 15 Financial Assistance CHINESE 12-07-16

No 15 Financial Assistance GERMAN 12-07-16

No 15 Financial Assistance SPANISH 12-07-16_ES-US (2)

No 15 Financial Assistance VIETNAMESE 12-07-16 (2)

 

Stewardship policy No 16

No 16 Collections ENGLISH 12-07-16

No 16 Collections CHINESE 12-07-16

No 16 Collections GERMAN 12-07-16_DE

No 16 Collections SPANISH 12-07-16

No 16 Collections VIETNAMESE 12-07-16

 

Providers Subject To Financial Assistance Policy at CHI St. Alexius, Carrington:  Click here:

Providers subject to financial assistance policy_03-31-17