Medical Group Financial Assistance

SSM Health commits itself to the people in the communities we serve. Every year, we provide millions of dollars in financial assistance to our patients. Our medical group financial assistance applications are different and vary by state. They are different from the forms submitted for hospital financial assistance.

To learn more about financial assistance options available, contact your medical group.

Submitting Medical Group Financial Assistance Forms

SSM Health has several medical groups. It is important to use the correct form for the medical group you are submitting an application for. Please take note of the submission guidelines as they are different across our medical groups.

To submit your financial assistance application, complete the form, and deliver by email, mail or fax.

Our financial assistance application and policy are available in 11 languages. Download an application in another language.

Deliver Completed Applications:

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

Email: financialaid@ssmhealth.com

Fax: 314-989-6734

To submit your financial assistance application, complete the form, and deliver by email, mail or fax.

Our financial assistance application and policy are available in 11 languages. Download an application in another language.

Deliver Completed Applications

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

Email: financialaid@ssmhealth.com

Fax: 314-989-6734

To submit your financial assistance application, complete the form, and deliver by email, mail or fax.

Our financial assistance application and policy are available in 11 languages. Download an application in another language.

Deliver Completed Applications

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

Email: financialaid@ssmhealth.com

Fax: 314-989-6734

To submit your financial assistance application, complete the form, and deliver by mail.

Deliver Completed Applications

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

Information for SSM Health Monroe Patients

Community Care Program

Persons currently approved for the community care program will continue to be eligible on services prior to or on March 11, 2022. For services performed on or after March 12, 2022 the community care program no longer applies and SSM Health financial assistance policy will be implemented.

Customer Service Contact Information

Our customer service phone numbers will be changing. Please ensure you are using the correct phone number and address.

For Services Occurring On or Before March 11, 2022

Monroe Clinic
2009 5th Street
Monroe, WI 53566

Call us Monday - Friday from 7:30 AM to 5:30 PM (CST) at 608-324-2808.

For Services Occurring On or After March 12, 2022

SSM Health Monroe Clinic Medical Group (Physician Billing)
PO Box 955978
St. Louis, MO 36195-5978

Call us Monday - Friday from 8:00 AM to 5:30 PM (CST) at 877-434-3326.

Community Care Program for SSM Health Dean Medical Group

The Community Care Program is a counseling program for uninsured or under-insured patients. The program helps determine eligibility for government or community-funded financial resources.

Each patient's situation and eligibility for resources is unique. The program helps patients access medical and family assistance resources available in Wisconsin.

Not all patients are eligible for public resources. In those cases, the program may provide temporary/limited assistance for physician-related charges.

All uninsured patients or patients experiencing a financial difficulty are eligible to apply.

Eligible and interested patients should print and complete a financial assistance application:

Note: you can pick up an application at the reception desk of all SSM Health Dean Medical Group locations.

You can also request an application by calling our community services specialists at:

  • 608-294-6463
  • 608-294-6439
  • Toll Free: 1-800-279-9966

Submitting your Community Care Program application for SSM Health Dean Medical group is easy:

Mail It:

Mail your application and documentation to:

SSM Health - Corporate Offices
Attn: Support Services
1808 W. Beltline Highway
Madison, WI 53713-9469

Fax It

Fax your application and documentation to 608-280-4520

Contact Customer Service

Customer service is available to answer questions you may have about financial assistance. Call our customer service team Monday – Thursday, 8:00 AM to 7:00 PM and Friday, 8:00 AM to 5:00 PM at 888-918-3512

Non-English Financial Assistance Documentation

Our Financial Assistance documentation is available to download in 11 languages: