Patient Financial Assistance

Jefferson Community Health & Life (JCH&L) is committed to providing an exceptional healthcare experience for every person, every time. JCH&L acknowledges the financial needs of patients and families who may be unable to afford the charges associated with the cost of medical care.

To manage its resources and responsibilities and to allow JCH&L to provide assistance to the greatest number of patients in need, the Board of Directors has established guidelines for providing Financial Assistance in accordance with a Financial Assistance Policy.

• Financial Assistance Policy Plain Language
• Financial Assistance Policy – summary of covered and non-covered providers
• Financial Assistance Policy
• Financial Assistance Guidelines

Patient Financial Assistance

Jefferson Community Health & Life provides medically necessary services to patients regardless of their ability to pay. Jefferson Community Health & Life provides financial assistance to patients who apply and meet the federal poverty guidelines.

Forms are available upon request, may be provided to patients who have a current self-pay balance if it is determined they may not have the means to make payment, or may be printed from this page.

To apply for financial assistance:

1. Complete the form by either typing or legibly printing.
2. Attach copies of your verification of income.
3. Sign and date the form.
4. Send the completed form to Jefferson Community Health & Life, PO Box 277, Fairbury, NE 68352.

For a patient financial application, click here.

Solicitud de Asistencia Financier (Spanish patient financial application), haga clic aquí

Upon receipt of the information, JCH&L will review the application, and you will be notified of the determination. Failure to submit all requested information will result in automatic denial of extended payments or financial assistance benefits.

For more information regarding Jefferson Community Health & Life Financial Assistance Policies, see the Jefferson Community Health & Life Financial Assistance Policy  or the Jefferson Community Health & Life Financial Assistance Policy Plain Language

For more information, contact the Jefferson Community Health & Life business office at 402.729.3351.

Patient Financial Information

Thank you for choosing Jefferson Community Health & Life for your healthcare services. Services at Jefferson Community Health & Life may be paid by commercial insurance, Medicare, Medicaid, or by the patient.

• Commercial insurance: When you were admitted, you were asked to show your insurance card to ensure proper submission of your bill. We will file your bill with your insurance carrier. You will be notified when your responsibility for the bill is determined.
• Medicare: We will submit your bill to Medicare. If you have a supplemental insurance or Medicaid in addition to Medicare, please notify the admission staff. We will also submit your bill to your supplemental insurance.
• Medicaid: We will submit your bill to Medicaid for payment. Please bring your Medicaid Eligibility Card when you are admitted. If you have a Medicaid application pending, or will be making an application soon, please notify the admissions staff. The Nebraska Medicaid Program pays for covered medical services for those persons who are unable to afford to pay for medically necessary services and who meet certain eligibility requirements. To apply for Medicaid, go to https://iserve.nebraska.gov/apply/start; or call (855) 632-7633 (Nebraska Department of Health and Human Services.)
• Private pay: The patient is responsible to pay the total charges. A statement will be sent to the patient. The Health Insurance Marketplace is a way to find health coverage that fits your budget and meets your needs. With one application, you can see all of your options and enroll. You can apply for private insurance, Medicaid, or the Children’s Health Insurance Program (CHIP.) Open enrollment runs from Nov. 1 through Jan. 31 each year. Apply at Healthcare.gov. You may apply at other times if you have had a life change (such as marriage, having a baby, losing your health insurance coverage, etc.)
• Financial Assistance: Jefferson Community Health & Life provides assistance to patients who apply and meet the federal poverty guidelines. Forms will be given to patients upon request or the form may be downloaded here . For more information, contact the business office at 402.729.3351.

Payment options:

• For patients who have health insurance, pay within 30 days of your first statement and take 5 percent off.
• For patients without health insurance, pay within 30 days of your first statement and take 25 percent off.
• Make payment arrangements paying your bill in a total of 10 months or less, and pay no interest.
• If you need to take longer than 10 months to pay you may be referred to a financial partner.

If you have a question about your bill, filing with insurance etc., please call the business office at 402.729.3351.