Northwest Community Hospital provides financial assistance for patients who need help with their medical bills.
Applying for patient financial assistance
To apply for patient financial assistance at NCH, please print the Financial Assistance Application and complete all necessary fields.
Please be sure to provide all requested documentation to be considered for financial assistance. Northwest Community Hospital is a charitable organization and provides financial assistance to those who are eligible. The Day Surgery Center is a for-profit organization, which also provides financial assistance to those who are eligible.
Forms available for download
To view a form, select a category, then select a language:
Self-pay patients eligible for discounts
We offer discounts for self-pay patients and financial assistance to uninsured patients who qualify.
NCH financial counselors can answer questions about your medical expenses. They also can discuss estimates for procedures, ask for and accept payments, collect self-pay balances prior to services/admission, set up payment plans, and help with completing applications for financial assistance for medical bills.
In addition, our financial counselors will review payment and funding options that may be available to you, including applications for Illinois Medicaid, Kid Care or Family Care programs, Illinois Violent Crime Victims' Assistance Fund, other government-sponsored plans, grants, community funding, financial assistance and/or charity care.