Financial assistance program

Financial assistance program purpose

Rogers Behavioral Health System, Inc. will provide, without discrimination, care for emergency mental health conditions to individuals regardless of their eligibility for financial assistance or for government assistance.

Financial assistance from Rogers comes with two expectations. Patients are expected to cooperate with Rogers’ procedures for obtaining other forms of payment or financial assistance and to contribute to the cost of their care based on their individual ability to pay.

Emergency services

Rogers Behavioral Health System’s policy is to provide emergency behavioral healthcare to stabilize patients, regardless of their ability to pay. Rogers’ staff are prohibited from engaging in actions that discourage individuals from seeking emergency medical care, such as demanding that emergency patients pay before receiving treatment or permitting debt collection activities in areas of the hospital where such activities could interfere with the provision, without discrimination, of emergency medical care. Following medical evaluation, non-emergent patients requiring financial assistance consideration will be reviewed and approved before additional services are provided.

Eligibility criteria for financial assistance

For individuals and families ineligible for full financial assistance, Rogers will grant partial financial assistance to those with an annual household income between 100 and 400% of the Federal Poverty Guidelines. Subject to the other eligibility criteria noted in this policy, patients eligible for financial assistance under this policy will not be charged individually more than the amount generally billed to individuals who have insurance covering such care (the "AGB"). Financial assistance for such individuals and families will be calculated as a percentage of total eligible charges according to the following schedule:

Percentage of Federal Poverty Guidelines Percentage of Financial Assistance
100% 100%
125%

87%

150% 75%
175% 60%
200% 50%
225% 44%
250% 38%
275% 32%
300% 25%
325% 19%
350% 13%
375% 7%
400% 0%

Limitations

Rogers’ financial assistance does not include all costs that may be associated with behavioral health services. Items or services that are not included in our financial assistance program include, but are not limited to, transportation, lodging, prescriptions, food, medical equipment, and pharmacy supplies.

Method of applying for financial assistance

Patients who want to apply for financial assistance, or who have been identified as a potentially eligible for financial assistance, will be informed of the application process either before receiving services, if the facts suggest potential eligibility, or after the billing and collection process has begun. The application process may be waived or suspended due to medical necessity, including timing and urgency of care. Patients or their representative can obtain a financial assistance application at no charge by mail by contacting Patient Financial Services at 262-303-2180 or at Rogers locations including 34700 Valley Road Oconomowoc, WI 53066 or by downloading and printing the financial assistance application here.

All patients/guarantors who receive a financial assistance application must complete and return the application, along with the following documents that serve as the minimum information necessary to process an application for financial assistance:

  • Proof of completion of medical assistance application process, as applicable;

  • Proof of household income (pay stubs for the past 90 days);

  • A copy of the three most recent bank statements from all banking or credit union institutions of the household;

  • A copy of the two most recent tax returns, including all schedules of patient, spouse, or any person who claims the patient as a tax dependent; and

  • Full disclosure of claims and/or income from personal injury and/or accident related claims.

Once it has been submitted, a Patient Financial Services representative will review the application. A patient’s application will be deemed complete after Rogers receives the financial assistance application with all information and the required documentation. Rogers reserves the right to request additional documentation before finalizing a request for assistance. You can find Rogers’ complete financial assistance policy here

Call 800-767-4411 or go to rogersbh.org to request a free screening.