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.

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 health benefits counseling program for SSM Health Dean Medical Group patients that helps uninsured or under-insured patients determine their eligibility for government or community-funded financial resources.

Depending on each individual's situation and eligibility, our Community Care Program will help patients access medical and family assistance resources that are available in Wisconsin.

For patients not eligible for public assistance, the Community Care Program may also provide temporary and limited assistance for SSM Health Dean Medical Group physician-related charges.

Who is eligible for assistance?

All SSM Health Dean Medical Group patients who are uninsured or experiencing a financial difficulty are eligible to apply for assistance.

How do I apply for assistance?

Interested patients should complete a financial assistance application:

If you are unable to print this form, applications are also available at the reception desks of all Dean Medical Group locations.

You can also request an application by calling our SSM Health Dean Medical Group Community Services Specialists: