Medical Group Financial Assistance

Our ministry is committed to the people in the communities we serve. Annually, SSM Health provides millions of dollars in financial assistance to our patients. Financial assistance applications for our SSM Health medical groups are often different and can vary by state than the financial assistance form submitted for our hospitals.

Please contact the billing office of your physician group to find out more about financial assistance resources available to you.

Financial Assistance Forms and Contacts

Submit your SSM Health Medical Group financial assistance application for Missouri, Oklahoma, Southern Illinois, SSM Health Dean Medical Group, and SSM Health Monroe Clinic Medical Group.

Complete the form and submit by email, mail, or fax.

Financial Assistance Application Form
The financial assistance application and policy are available in several languages. Download application in another language.
For Fond du Lac, Wisconsin submit your SSM Health Fond du Lac Regional Clinic financial assistance application.

Email
financialaid@ssmhealth.com

Mail
SSM Health: Patient Financial Services
Attn: Financial Assistance
PO Box 411997
St. Louis, MO 63141

Fax
314-989-6734

SSM Health Fond du Lac Regional Clinic

To submit your SSM Health Fond du Lac Regional Clinic financial assistance application, complete the form and submit by mail.

Mail:
SSM Health Samaritan Clinic
430 E. Division Street
Fond du Lac, WI 54935

Contact Customer Service

For more information about financial assistance, contact an SSM Health customer service representative toll free at 888-918-3512, Monday - Friday, 8 AM to 5 PM CST.