Financial Assistance Policy
Financial Assistance Application
Financial estimation tool:
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Mercy Hospital of Devils Lake
Financial Assistance Availability Notification
Notice of Availability of Financial Assistance Options:
Extended Payment Arrangements, Payment Discounts for Uninsured Patients, and Charity Service Determinations are available to those who apply and qualify for these forms of financial assistance.
Mercy Hospital has applications available upon request for all patients who wish to seek assistance in meeting their financial obligations with us. Mercy Hospital provides care, without regard to ability to pay, to individuals with limited financial resources, and offers all patients the option to apply for financial assistance.
The first step in this process is completion of a Mercy Hospital Financial Assistance Application. The application is readily available at the hospital admission desk, business office,and the Comunity Resource coordinator, or may be mailed to you upon request. or may be downloaded from the website. Please complete the application in it's entirety, attach requested information, and return it to Mercy Hospital, Attention: Business Office.
Our application process will require your cooperation in seeking public assistance for those who appear to be eligible for such assistance. this process requires that various applications be completed by the patient or responsible party with those agencies.
If you need assistance with our Financial Assistance Application, or if there are other issues you think we should be aware of, please contact us. Your Patient Account Representative is your primary contact with Mercy Hospital regarding your hospital bill. You may call Mercy Hospital and ask for the Business Office if you have questions regarding this application.
All information you provide to us is held in strict confidence and will not be shared without your permission.
If you are uninsured for the full balance due, you may qualify for an extended payment plan and a payment discount.
Call 701-662-2131 and ask for the Business Office Monday-Friday 7:30 a.m. to 5:00 p.m.
Patient Financial Policies:
Click here to view our Patient Financial Policy
Mercy Hospital now offers secure online bill payment