Ascension Calumet Hospital
Locations

Ascension Calumet Hospital

  • Hospital/Medical Center
  • Emergency Care
  • Laboratory
  • Imaging
  • Urgent or Express Care
  • Specialty Care
  • Primary Care/Clinic
  • Mammography
Address

614 Memorial Dr
Chilton,  WI  53014

Phone
920-849-2386
Appointments
Departments
Financial Assistance
If you’re uninsured or have trouble paying for healthcare, Ascension may be able to help through our financial partnerships and resources.

Summary of Financial Assistance Policy

Ascension has a commitment to and respect for each person’s dignity with a special concern for those who struggle with barriers to access healthcare services. Ascension has an equal commitment to manage its healthcare resources as a service to the entire community. In furtherance of these principles, Ascension provides financial assistance for certain individuals who receive emergency or other medically necessary care from Ascension. This summary provides a brief overview of Ascension’s Financial Assistance Policy.

Financial Assistance Policy Summary

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Financial Assistance Policy

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Providers Not Covered by Financial Assistance Policy

Ascension NE Wisconsin – Mercy Campus, Ascension NE Wisconsin – St. Elizabeth Campus, Ascension Calumet Hospital

What Services Are Covered?
The Financial Assistance Policy applies to emergency and other medically necessary care. These terms are defined in the Financial Assistance Policy. Elective services are not covered by the Financial Assistance Policy.

How Can I Apply?
To apply for financial assistance, you typically will complete a written application and provide supporting documentation, as described in the Financial Assistance Policy and the Financial Assistance Policy application.

Financial Assistance Application

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Who Is Eligible?
Financial assistance is generally determined by your total household income as compared to the Federal Poverty Level. If your income is less than or equal to 250% of the Federal Poverty Level, you will receive a 100% charity care write-off on the portion of the charges for which you are responsible. If your income is above 250% of the Federal Poverty Level but does not exceed 400% of the Federal Poverty Level, you may receive discounted rates on a sliding scale. Patients who are eligible for financial assistance will not be charged more for eligible care than the amounts generally billed to patients with insurance coverage.

What If I Am Not Eligible?
If you do not qualify for financial assistance under the Financial Assistance Policy, you may qualify for other types of assistance. For more information, please contact Customer Service at Ascension by telephone at 1-877-348-9718.

How Can I Get Help with an Application?
For help with a Financial Assistance Policy application, you may contact Customer Service at 1-877-348-9718.

How Can I Get More Information?
For help with a Financial Assistance Policy application or to request copies of the policy, you may:

  1. Request this information at any Ascension hospital or clinic.
  2. Call Customer Service:

Billing and Collection Policy

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Amount Generally Billed (AGB) Policy

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Working with local, state and national leaders, we advocate for solutions to cover the uninsured and underinsured. In addition to our Financial Assistance Program, these resources provide helpful information: