Financial Assistance

Charity Care Program

Financial Assistance

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 Avenue
Newark, NJ 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.

Pricing Resources

Following are standard charge lists for certain procedures. However, the actual amount paid by any patient varies widely and primarily depends on the type of insurance, if any, that the patient has. For uninsured and underinsured patients who may qualify, there are financial assistance and discount programs available through our hospital, and staff who can assist with eligibility for government programs such as Medicaid.

If you are interested, you may view our standard charges or our average inpatient procedure price report.