Sisters of Mercy Urgent Care, Inc. is a not-for-profit organization dedicated to providing medical care regardless of one's ability to pay. As part of our commitment to care for and to serve the needs of the community, we have a compassionate care program to help patients without financial means to pay for their health care services.
Financial Assistance Policy
- All patients who have or anticipate a bill with Sisters of Mercy Urgent Care may apply for financial assistance.
- Our policy applies to health care services provided throughout all of our Urgent Care locations. STD (Sexually Transmitted Disease) screening will not be covered by Compassionate Care. An application must be submitted for each new visit.
- Our policy applies to patients with or without insurance benefits (insurance cannot be filed and you must qualify for the program).
- Patients eligible for financial assistance receive discounts off balances owed. Discounts are determined using criteria such as household income, and other fund sources available. Based upon these criteria, you may be eligible to receive a 100% ($20 co-pay), 75% or 50% discount.
- Submitting an application does not guarantee that assistance will be granted.
Financial Assistance Process
- Complete the PDF application located at this link.
- Programa Assistancia Financiera de Compassionate Care(Necesitará el gratis Adobe Reader para leerlo.Descárguelo aquí)
- Haga clic aquí para descargar la solicitud en español .
- Income information must be provided for all income-producing family members in the immediate household
- Bring completed/signed application and supporting documents to any Sisters of Mercy location at the time of your service. The following supporting documents MUST be provided:
- Previous year's 1040 tax return (preferable)
- Prior year W-2s or current payroll stub
- If you do not have income, we cannot determine eligibility; you will need to contact the IRS at 800/829-0922. They can provide you with either your most current 1040 or proof that a tax return has not been filed.
- Our receptionists will take your compassionate care form and based on your substantiated income level, you will pay an amount based on a discounted self-pay tiered schedule (tiers are based on comprehensive level of service):
|Qualify||Tier 1||Tier 2||Tier 3|
FULL Payment is required at time of visit for discounted services through our compassionate care program.
Questions? The Sisters of Mercy Urgent Care staff is happy to answer any questions you may have about the Compassionate Care Program. We may also be able to refer you to other agencies that provide financial assistance for healthcare. Please call us at (828) 252-8957, Option 2.