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Financial Assistance


The mission of Mercy Medical Center and Catholic Health Initiatives is to nurture the healing ministry of the Church by bringing it new life and viability in the 21st century. Fidelity to Gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities.


In light of our mission, Mercy Medical Center offers financial assistance to help with medically necessary treatment and procedures, whether it is by absorbing part of the cost based on need, or helping to identify community or governmental programs to meet your needs. This program does not cover cosmetic surgical packages. Financial assistance is specific to each patient. Guidelines are used to determine eligibility based on family income.


In some instances patients may be presumed to be eligible for financial assistance based on the completion of a short questionnaire. New admissions or re-admissions will be screened for changes in eligibility for financial assistance. Mercy Medical Center’s decision to provide financial assistance in no way affects the responsible party’s financial obligations to physician or other health care providers.


Mercy’s financial assistance is secondary to all other financial resources available to patients. Mercy’s Patient Financial Counselors are here to help and are available to explain paperwork and answer your questions. If you feel this financial obligation may be a hardship for you and you wish to apply for financial assistance, please print this application and complete, or call one of our Patient Financial Counselors:





Applications are also available at Mercy’s main Admission’s desk and at Mercy’s Business Office.

Options for Financial Assistance

Applications for financial assistance are available online: Click here to print an application (English) or Haga clic aquí para imprimir y aplicación en español.  Please contact a Patient Financial Counselor for help filling out the form and completing the application process.

What Is Covered

Mercy’s financial assistance is available to cover medically necessary services provided by Mercy Medical Center in Roseburg, Oregon, including hospital care. Medically necessary is any procedure that meets the guidelines set forth by the Oregon Health Plan. The Oregon Health Plan was developed with extensive citizen input that created a prioritized list of health conditions and treatments. The list is maintained and updated by the Oregon Health Services Commission. The conditions and treatments are ranked for importance to health, and are funded by the State for patients covered under the Oregon Health Plan. This list serves as a model for basic and necessary health care for Oregon’s citizens. Basic and necessary health care does not cover all possible procedures.

Government and Community Programs

Mercy cannot meet the needs of all patients who are unable to cover their medical bills. For this reason, patients without insurance coverage must take advantage of programs for assistance for which they qualify. This helps ensure that Mercy’s limited resources will be available to patients who don’t qualify for other financial help.


One of Mercy’s Patient Financial Counselors will work with you to determine your eligibility for government and community programs that may help cover medical expenses. The financial counselor is available to assist you in applying for these programs.

Financial Assistance for Those Unable to Pay the Full Cost of Care

Mercy Medical Center is a part of Catholic Health Initiatives (CHI), a nonprofit health organization with a longstanding commitment to assist those who seek our care, regardless of ability to pay.

If you are unable to pay for all or part of the care you receive from our hospital, you may be eligible for free or discounted services. Please read the information below to understand:


How eligibility for financial assistance is determined

How to apply for financial assistance.

This information is a summary of the national CHI policy. Please click here to read the policy in full.


Please Note: Any patient seeking emergency care will be treated without regard to ability to pay.


How eligibility for financial assistance is determined

To determine your eligibility for financial assistance, we consider:


The medical necessity of services received. In short, medically necessary services save your life, make you well, or prevent a medical condition from becoming worse. There is a detailed definition of medically necessary services in the CHI policy.

Medical necessity will be determined by a physician.  In determining medical necessity, we follow all requirements of the federal Emergency Medical Treatment and Active Labor Act and applicable laws and regulations.


Your ability to pay for the services. We look at income, family size, and available resources and expected future income (minus living expenses).

You may qualify for 100% of your care provided for free, or a discounted charge under one or both of these criteria:


Your family income is low.  Free care may be available to patients with family income less than or equal to 130 percent of the Department of Housing and Urban Development (HUD) very low  income guidelines for the area; and/or

You are considered medically indigent. This means that paying the full cost of your medical care, after any health insurance payment, would cause you to become impoverished. This could apply if you are uninsured, underinsured, or suffer a catastrophic illness.

How to apply for financial assistance

When you are registered as a patient, we will ask about your coverage for health care services. If you don’t have coverage or it is not likely to be sufficient, we will either give you a packet of information that covers our financial assistance policy or offer the immediate assistance of a financial counselor, who will go over the financial assistance application with you.


You will need to complete the Financial Assistance Application form, provide all information it requests, and submit it to us.

If it is determined you are eligible for assistance, we will notify you and let you know how much assistance is available. If it is determined you are not eligible for assistance, we will let you know that in writing and give a brief explanation of the reason.


It’s important to note that if you do not have insurance, you will not be charged more for services than the amount generally billed to those who have insurance.


Once again, this is a summary of the CHI national financial assistance policy. You can read the full policy here.  If you have any questions about qualifying or applying for financial assistance,  please contact

Discounts for Patients Who Don't Qualify for Financial Assistance

For patients who do not qualify for our Financial Assistance Program, Mercy Medical Center extends a deeply discounted rate plan for medically necessary services. Each year, Mercy reviews and establishes an average managed care contractual allowance and applies this discount to all uninsured patients who are eligible. To determine your eligibility, the amount of your discount and the terms of your payment, please contact a Mercy Business Office representative.

Payment Plan Options

After all available health insurance coverage, discounts and financial assistance have been applied to a medical bill, there still may be a remaining balance. Although this balance is your responsibility to pay, a financial counselor or business office representative can work with you to set up a payment plan.

Financial assistance application

CHI Mercy Health   Mercy Medical Center   2700 NW Stewart Parkway   Roseburg   Oregon  97471   541.673.0611




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