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    Financial Assistance

    Deaconess Illinois Clinic treats all patients, regardless of their ability to pay, for emergent and medically necessary care. If you know that you will be unable to pay your medical bills, contact the Patient Financial Services team immediately. Our staff will work with you to create a plan that fits your situation.

    We offer financial assistance to low-income individuals and families, in addition to no-interest payment plans. We can usually work with patients to prevent bills going to collections or beyond, but you must contact us. We can’t help you if we don’t know you need help.

    To be considered for financial assistance, please complete and submit an application (with requested attachments). If more information is needed to process your application, our financial assistance representatives will reach out to you.  Processing your application may take 10-14 days.  Additional processing time may be needed if more information is required.




    To learn more, contact the Financial Assistance team at 812-450-3435.  Representatives are available Monday-Friday, 7 AM to 3:30 PM (CST), excluding major holidays and the Friday after Thanksgiving.

    During the financial counseling process we will figure out if you qualify for health insurance coverage through federal or state programs such as Medicaid.  If you are eligible for one of these programs, we will ask that you apply for coverage.  Our team at The WellFund will reach out to you.  They can be reached at 812-450-2124 or 855-365-9300 if you have any questions on applying for coverage.
    Your application may be completed and returned in several ways:
    Download the fillable application and type your information directly on the form.  This will allow you to sign electronically.  Save the completed form to your documents.  You will then be able to return the form, proof of income, and other necessary documents as attachments via email to
    Mail or Fax
    Download and print the application.  Fill the application out complete with black ink only, writing as much detail as possible.  Mail the form, proof of income, and other necessary documents to

    Deaconess Financial Assistance
    PO Box 3366,
    Evansville, IN 47732-3366
    or Fax to 812-450-5261

    Only for patients of the following providers:

    • Jeffrey Lehman MD - Allergy & Immunology
    • Dennon Davis MD - Family Medicine
    • Efstathios Karamanos MD - Plastic Surgery
    Patients with a balance of $1,000.00 or more may now apply directly for financial assistance using MyChart. Just log in to MyChart, click on Your Menu and choose Financial Assistance under Billing. You will be guided to input your application information and upload all necessary documentation before submitting the information securely via MyChart. For balances less than $1,000.00, download the application and submit with all requested attachments via email, mail or fax. See below for further instructions.



    Rural Health Clinic Financial Assistance

    The Rural Health Clinic Financial Assistance program is designed to provide free or discounted services to uninsured or underinsured patients receiving care at the following Deaconess Clinics:

    • Deaconess Clinic – Fort Branch
    • Deaconess Clinic – Morganfield
    • Deaconess Clinic – Oakland City
    • Deaconess Clinic – Petersburg
    • Deaconess Clinic – Princeton
    • Deaconess Clinic - Sebree

    Discounts will be based on a sliding fee scale up to 350% of the Federal Poverty Level Guidelines. The discount will apply to all services received during one clinic visit. A new application must be completed for every visit to the clinic. 

    If you have received care at one of these clinic locations and would like to apply for assistance, please download the fillable application below. 

    You may return this application in one of the following ways: