Financial Assistance Application

In accordance with our Mission and Values, Providence Hospital is committed to caring for all people regardless of their ability to pay, with special attention to those who are poor and vulnerable. Providence Hospital offers financial counseling and assistance to help address any financial concerns patients or families may have regarding their care. Our financial aid policies, which can be found below reflect Providence Hospital’s dedication to working together with our patients in a compassionate and caring manner to identify options for resolving their financial obligations. Help is available by calling 251-266-1500,  emailing us or visiting in person at any of our facilities.

Providence Hospital is a ministry of Ascension Health, one of the nation’s largest Catholic healthcare systems. We are driven by our mission to serve all persons, with special attention to those who are poor and vulnerable. Every day, our financial counselors assist individuals who do not have health insurance. Our health system provides assistance to uninsured patients who demonstrate need, based on incomes as well as their assets and the size of the medical bill. We are committed to a fair billing system to ensure that all patients are treated with dignity and respect. Our financial assistance to the poor and uninsured includes the following elements:

  • Charity care: For poor or low-income patients determined by our financial counselors to be eligible for charity care, we will provide up to the entire cost of their hospital care at no charge to the patient. The charity care guidelines take into account the patient’s household income, assets and the size of their medical bills.
  • Uninsured Patients with Means to Pay: Not all uninsured patients are poor or qualify for charity status. However, regardless of ability to pay, all uninsured patients will receive a 64 percent discount on their hospital bill. Providence Hospital also provides an additional 10 percent prompt pay discount to uninsured patients who pay their bills on or before the date of service. Some elective services are not eligible for the discount, i.e., cosmetic services, Wellness Center, etc. The discount is for the hospital billing only. If you are interested in obtaining insurance coverage please visit our Community Resources page.
  • Other assistance: Providence Hospital also assists patients in the process of qualifying for Medicaid and other programs, and we offer extended payment options for those who do not qualify for charity care.


The Patient Accounts Representative will provide a financial statement to any patient/guarantor who requests one, or anyone the Patients Accounts Representative feels may be a candidate for charity.  At times it may be necessary to take this information over the telephone, with the condition that the patient will mail all supporting documentation within two weeks if the personal credit history does not match the financial statement.

Income is defined as total cash receipts before taxes from all sources.  These include money, wages, and salaries before deductions, receipts from self-employment (includes farm income after deduction for expenses), payments from public assistance, social security, unemployment, workers’ compensation, strike benefits, child support, military allotments and any other sources of income.

Contact Information

A Patient Account Representative may be contacted at 251-633-1566 for any additional information.

To download a copy of our financial assistance application, please click here.