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.

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. Jefferson Community Health & Life works with MedPlan, a business partner which handles billing and reviews applications for patient financial assistance. 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.

Upon receipt of the information, MedPlan 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 2022 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. Avadyne, a payment center contracted by Jefferson Community Health & Life, will notify you 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. The local navigator for the Health Insurance Marketplace can help you with Medicaid application, or you can call the local office of the Nebraska Department of Health and Human Services at 402.729.6168 for an appointment.
  • Private pay: The patient is responsible to pay the total charges. A statement will be sent to the patient by Med-Plan, a payment center contracted by Jefferson Community Health & Life. 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. 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.) The local navigator is Cortney Hartz, located at Blue Valley Community Action, 620 Fifth Street, Fairbury, Neb. For information or to make an appointment, call 402.729.2278, ext. 136.
  • Charity care: Jefferson Community Health & Life provides assistance to patients who apply and meet the federal poverty guidelines. Forms will be given to patients upon request. For more information, contact the business office at 402.729.3351.

Payment options:

  • Pay within 30 days of your first statement and take 5 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 will be referred to Union Bank for a low-interest loan.

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

Price Information

At Jefferson Community Health & Life, we understand that you may need to determine how much a procedure or service will cost prior to receiving the service. We are committed to transparency and helping consumers understand health care pricing.


For an estimate of what your cost will be for a service, please have your insurance information available and click here:

If you need help determining how much a service or procedure at the Jefferson Community Health & Life will cost, please contact us at 402.729.3351 or email

**Please note: Actual costs may vary from estimates depending on actual services performed or timing issues with other payments affecting the patient’s deductible.


For a list of standard charges at JCH&L, please click here: 470468078 Jefferson Community Health & Life Standard Charges 

The standard charges list gives the dollar amount set for each service before insurance contract/benefit plan discounts, self-pay discounts or financial assistance is applied.

Charges vary between patients for the same service at the same health care facility based on many factors, including (but not limited to) complications and pre-existing conditions.

If comparing charges between health care facilities, remember facilities may include different items with the base charge. 

If you need help in determining what a standard charge covers or what means, please contact us at 402.729.3351 or email

For more information, view the Consumer Guide to Healthcare Prices.