At Lake Forest Hospital, we understand that medical expenses are often unplanned. In the event of financial hardship, we help our patients explore available resources to resolve their medical bills — and ensure that all patients receive high-quality care without regard for their individual ability to pay.

Healthcare Financial Assistance Can Help
Full or partial assistance may be available based on your financial condition. The Healthcare Financial Assistance application is used to determine eligibility. If approved, this program covers medically necessary services provided by Lake Forest Hospital and our Emergency Room Physicians. It does not apply to any other fees you may incur.

How to Apply
To be considered for a full or partial discount under our Healthcare Financial Assistance (HFA) policy, you must provide the information and documentation requested in the application. You must also apply for other existing financial resources that may be available to pay for your healthcare, such as Medicare, Medicaid, Kidcare, Family Care, Worker’s Compensation, and other liability claims.

Please complete the HFA application (English) or Aplicación para Asistencia Financiera Medica (Español) and return to the address on the form with all supporting documentation, including:

• Copy of last year’s tax return, all schedules and W2 forms
• Copy of last three (3) months’ pay stubs or proof of other income
• Copy of last three (3) months’ bank statements
• Copies of all outstanding bills: automobile, medical bills, credit card statements, etc.

What Happens Next?
Once the complete application is received, a determination will be made and a written response will be sent to the applicant within thirty (30) working days of receipt. If you have any questions or require additional assistance in completing the application, please call our Customer Service Department at (847) 535-6100.

For more information, view our Frequently Asked Questions or download one of the following applications below:

• Application for Healthcare Financial Assistance
• Aplicación para Asistencia Financiera Medica

Frequently Asked Questions

What is Healthcare Financial Assistance?
Healthcare Financial Assistance, (HFA), is Lake Forest Hospital’s program to reduce or eliminate charges for medically necessary healthcare. If you qualify, your bill for hospital services may be reduced or eliminated. However, you will still need to contact the physicians involved in your care to discuss payment arrangements for their charges.

How can I qualify for HFA?
You may request an application form at any Registration area, or by contacting Customer Service directly at (847) 535-6100. Your eligibility is determined after completing the Healthcare Financial Assistance application, applying for any other programs, such as Medicaid, which may help pay for your care, and providing supporting documents such as tax forms and paycheck stubs.

Approval is based on financial need using an income and asset formula that accounts for past, present and expected future resources. Generally, partial bill waivers are available for those earning up to three times the Federal Poverty Guidelines. There are two types of approval:

• Full = 100% of remaining Lake Forest Hospital (LFH) and our Emergency Room (ER) physician charges are waived.
• Partial = A portion of LFH and our ER physician charges are waived, and a payment plan is arranged for the remaining balance.

I have insurance, but cannot afford to pay the deductible and/or coinsurance. What can I do?
If you qualify, Healthcare Financial Assistance can be used to waive a portion of the amounts you would normally be responsible for, up to 100% of Lake Forest Hospital charges. HFA is always applied after any and all insurance payments or legal settlements.

What about fees from doctors and other health professionals for my care?
Although HFA covers the cost of medically necessary services performed by Lake Forest Hospital, it does not cover the cost of services billed by independent groups, such as private physicians and specialty care groups (other than our ER physicians). You must contact the physicians involved in your care to arrange payment plans or explore other arrangements.

If I do not qualify for Healthcare Financial Assistance, do I have any other options?
Yes. Lake Forest Hospital reviews each case independently, and will assist you in establishing a payment plan and/or directing you to other community resources that may be able to help.

What if I do not agree with the Healthcare Financial Assistance determination?
You have the right to appeal the decision by providing any information you believe supports your qualifications to the Director of Patient Financial Services.

If you need or have already received services at Lake Forest Hospital, and might have difficulty paying your portion of the hospital bill, please contact:

Billing Questions
Contact our Customer Service Representatives
(847) 535-6100
8:30 - 4:00 weekdays
or contact us anytime online >