Ascension Via Christi St. Teresa

Financial Aid for Your Hospital Bill

At Ascension Via Christi Hospitals, patients receive necessary medical care, regardless of their ability to pay. Services are provided without regard to culture, age, gender, sexual orientation, spiritual beliefs, socioeconomic status, language or disability. Trained financial counselors are available to discuss individual needs.  We will review your eligibility for financial assistance and assist you in making payment arrangements.

If you feel you need financial assistance, please print and complete the financial assistance application form below:

Our mailing address for completed forms:
Ascension Via Christi
Attn: Financial Counseling Department
P.O. Box 3870
Wichita, KS  67201

Additional income, asset and expense information may be requested upon review of the completed financial assistance application.

Financial counselors are available Monday through Friday 8 am – 4:30 pm. For additional assistance please contact a counselor associated to the location where services were performed.

Financial Assistance Application

• Financial Assistance Application (PDF)
• Aplicación de Asistencia Financiera  (PDF)
• Đơn Xin Trợ Giúp Tài Chánh (PDF)

Financial Assistance Policies

• Financial Assistance Policy (PDF)
• Política de Asistencia Financiera (PDF)
• Chính sách hỗ trợ tài chính (PDF)

Summaries of the Financial Assistance Policy

• Summary of Financial Assistance Policy (PDF)
• Resumen de la Política de Asistencia Financiera (PDF)
• Tóm Lược Chính Sách Trợ Giúp Tài Chánh (PDF)

Lists of Providers Covered by the Financial Assistance Policy

• Providers covered by the financial assistance policy (PDF)
• Proveedores cubiertos por la póliza de asistencia financiera (PDF)
• Nhà cung cấp bao phủ bởi các chính sách hỗ trợ tài chính (PDF)

Amount Generally Billed Calculations

• AGB (English)
• AGB (Spanish)
• AGB (Vietnamese)

Billing and Collection Policies

• Billing and Collection Policy (PDF) - English
• Política de facturación y cobro (PDF)
• Chính sách thanh toán và thu tiền (PDF)

Contact Us

Hours
Monday-Friday
8 am-4:30 pm

Ascension Via Christi Hospitals in Wichita
316-268-5178, option 2

Ascension Via Christi Hospital in Manhattan
785-565-4794, option 2

Ascension Via Christi Hospital in Pittsburg
888-313-7158, option 2

Wamego Health Center
785-458-7000, option 2