Charity Care Information
SRMC is dedicated to providing healthcare services to individuals in need of medical attention regardless of their ability to pay. It is the policy of SRMC to treat all patients and guarantors equally, fairly, and consistently. To assist patients facing financial challenges, we offer Charity Care (Financial Assistance). If you lack insurance, are underinsured, or don’t qualify for adequate coverage from any government program, you may be eligible for Financial Assistance. Please note that Charity Care is typically a supplement to other available financial resources for the patient.
Eligible Services
Patients who have outstanding balances and medical service dates within six months of the approval date may be eligible for Financial Assistance if they have medically necessary services. If needed, the examining physician will make the final decision on the medical necessity of these services.
Eligibility Requirements
In order to qualify, patients must be residents of Cheyenne or Deuel County and reside within a 20-mile radius of Sidney. Charity Care will be determined by considering factors such as household income and size, real estate, personal property, and investment equity. Additionally, credit will be granted for any existing medical loans in comparison to the Federal Poverty Guidelines for the current year.
The Department of Health and Human Services (DHHS) releases the poverty guidelines annually through the Federal Register. Households meeting the criteria of being at 100% of the poverty level are entitled to receive free care. Discounted care is also provided for households up to 300% of the poverty level. Eligible individuals shall not be charged more than the average amount billed for emergency and medically necessary services.
A physical copy of the application is available at the SRMC Patient Financial Services, located at 645 Osage Street, Sidney, NE 69162, and can be requested via mail by sending a written request to this address. Applications are also available at Admissions in the main SRMC facility, located at 1000 Pole Creek Crossing. If you need assistance with the application process, you may visit the Patient Financial Services department in person or call them at 308.254.8778.
If there is knowledge, evidence, or questionable information within the application process, supporting documentation will be required before eligibility is determined. Supporting documentation may be requested on financial assistance greater than $5,000. The required supporting documentation should be obtained from the present year or from the most recently available sources. The supporting documents may include W-2 forms, tax returns, vehicle registration, property tax evaluations, bank statements, unemployment statements, and a Medicaid denial letter, if applicable.
If you require assistance, we have a language translation line available to better support you. Please note that while we do our best to support our community, SRMC is not obligated to provide this application in multiple languages considering the demographics of our population.
How to Apply
Apply by completing an application over the phone, in person, online, or by downloading and printing the application.
The Patient Financial Services department can assist you with the application process. To receive a physical copy of the Financial Assistance application, please visit our office at 645 Osage Street, Sidney, NE 69162.
Payment Options
If you would like to pay online, please click this link. Other payment options are also available for your convenience: We kindly request that you include your account number with payment.
Pay By Mail
Send to: SRMC Attn. PFS Dept. at 1000 Pole Creek Crossing, Sidney, NE 69162
Pay In Person
Visit 645 Osage Street, Sidney, NE 69162
Pay By Phone
Call one of our Patient Financial Specialists at 308.254.8778, or e-mail [email protected]