Financial Assistance

Charity Care Program at Saint Michael’s Medical Center

The Charity Care program is designed to help you with your hospital bills. Eligibility is based upon your income and assets on the day you receive treatment. The program does not cover physician fees. The documents listed below may be requested to complete your Charity Care Application:

  • Pay stubs or a letter from your employer on letterhead providing a breakdown of your gross salary (pay stubs for one month, thirteen weeks, or 52 weeks prior to date[s] of service)
  • A Social Security benefit letter (covering date[s] of service)
  • A copy of your checking/savings account statement (covering date[s] of service)
  • Personal Identification documents
  • A Welfare benefit letter (covering date[s] of service)
  • Pension, IRA, Mutual Fund, or Stock documentation (covering date[s] of service)
  • Proof of N.J. residency (prior to date[s] of service)

Be sure you have read and understood the income and asset criteria listed on the application.

To apply for the Charity Care program, download and complete the forms provided below. Your completed application should be mailed to:

Saint Michael’s Medical Center
Attn: Charity Care Department
Building C, 3rd Floor
111 Central Ave
Newark, New Jersey 07102

For additional assistance, please contact us, at (973) 877-5195, (973) 877-2709, or (973) 877-2467.

Forms

Use the free Adobe Acrobat Reader to view and print the forms listed below.

We support price transparency. For our patients to understand their potential financial liability for hospital services, we are making our hospital charges available to patients. Hospital charges vary based on the type of care provided. The price can differ from patient to patient for the same services. The price will be different for complications or different treatment for the patient's personal health condition. Patients also may qualify for financial assistance. Please contact ALLEGIANCE at 973-233-5003 or our Financial Counseling Department at 973-877-5195 for a price estimate or to find out if you qualify for assistance.