Charity Care Program
The Charity Care program is designed to help you with your hospital bills. Eligibility is based upon your income and assets on the day you receive treatment. The program does not cover physician fees. The documents listed below may be requested to complete your Charity Care Application:
- Pay stubs or a letter from your employer on letterhead providing a breakdown of your gross salary (pay stubs for one month, thirteen weeks, or 52 weeks prior to date[s] of service)
- A Social Security benefit letter (covering date[s] of service)
- A copy of your checking/savings account statement (covering date[s] of service)
- Personal Identification documents
- A Welfare benefit letter (covering date[s] of service)
- Pension, IRA, Mutual Fund, or Stock documentation (covering date[s] of service)
- Proof of N.J. residency (prior to date[s] of service)
Be sure you have read and understood the income and asset criteria listed on the application.
To apply for the Charity Care program, download and complete the forms provided below. Your completed application should be mailed to:
Saint Michael’s Medical Center
Attn: Charity Care Department
Building C, 3rd Floor
111 Central Avenue
Newark, NJ 07102
For additional assistance, please contact us, at 973-877-5195, 973-877-2709, or 973-877-2467.
Use the free Adobe Acrobat Reader to view and print the forms listed below.
Estimate My Cost
Saint Michael’s Medical Center wants to make the billing process as simple as possible for you. Determine how much a service or procedure might cost by exploring our interactive estimator tool.
The standard charges provided on this website are not a guarantee of what you will be charged or the amount you will owe. Your actual charges may be different from the standard charges for many reasons including, but not limited to, the seriousness of your medical condition, your physician’s treatment decisions, your health care needs, and the services you receive. Additionally, these standard charges do not include charges for all the items and services provided by the hospital. Some pharmacy items, supplies, and other items and services do not have standard charges. These standard charges do not include any physician charges (e.g., office visits, surgeon fees, anesthesiologist fees, emergency room physician fees, radiologist fees, pathologist fees, or other consulting physician fees, etc.). Please consult with your health plan if you need help understanding your benefits. If you have insurance or other health care coverage, your benefits will determine the amount you owe.
By clicking ‘view our standard charges’ below, you accept the above disclaimer agreement and acknowledge that if you obtain health care services, the amount you will be required to pay may be different from the standard charges provided on this web page.
Protections Against Surprise Medical Bills
To learn more about your rights and protections against surprise medical bills, click here.