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Catholic Health Initiatives

Financial Assistance Policy

 

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 Phyllis Bannon; (979) 415-2226


CHI St. Luke’s Health - Brazosport
Business Office
194 Abner Jackson Drive
Lake Jackson, Texas 77566-5160

 Phone: (979) 299-2882

Providers Covered and Not Covered by Hospital Financial Assistance Policy.pdf

Financial Plain Language Summary - English.pdf
Financial Plain Language Summary_Spanish
Financial Plain Language Summary_Chinese.pdf
Financial Plain Language Summary_German.pdf
Financial Plain Language Summary_Vietnamese.pdf

No 15a Financial Assistance Application English
No 15a Financial Assistance Application 4-2016_Spanish 
No 15a Financial Assistance Application 4-2016_ZH-Chinese.pdf
No 15a Financial Assistance Application 4-2016_German.pdf
No 15a Financial Assistance Application 4-2016_Vietnamese.pdf

Stewardship Policy No 15 Financial Assistance Final 2016_English.pdf
Stewardship Policy No 15 Financial Assistance Final 2016_ES-US.pdf
Stewardship Policy No 15 Financial Assistance Final 2016_ZH-CN.pdf
Stewardship Policy No 15 Financial Assistance Final 2016_DE.pdf
Stewardship Policy No 15 Financial Assistance Final 2016 w_VI.pdf

Stewardship Policy No 16 Collections Final 2016.pdf
Stewardship Policy No 16 Collections Final 2016_ES-US.pdf
Stewardship Policy No 16 Collections Final 2016_ZH-CN.pdf
Stewardship Policy No 16 Collections Final 2016_DE.pdf
Stewardship Policy No 16 Collections Final 2016_VI.pdf

These documents are also available in the Emergency Room, if any, and admissions areas of the hospital.