Gundersen Health System would like to help as much as possible with any medical expenses that you or your family may accumulate at any of our facilities. All patients who feel that they may be eligible for Financial Assistance are encouraged to apply. Financial assistance application forms are available upon request and without charge. However, we would ask that you first contact your county to see if you may be eligible for any government programs before completing our form for assistance (see listing below). If you do not qualify through your county, a copy of the denial will need to be sent
with Gundersen’s Financial Assistance Application.
In order to qualify for potential financial assistance through Gundersen for medical bills, you will need to complete this form. Please include a copy of pay stubs for the last 30 days, your last year’s federal and state income tax returns, as well as a letter explaining your current financial situation.
Please send completed information to:
Gundersen Health System
Attn: CFS NCA3-01
PO Box 4444
La Crosse, WI 54602-4444
If you have any questions, call our Customer Financial Services department at (608) 775-8660 or (800) 362-9567, ext. 58660 from 7:30 a.m. to 5:30 p.m., Monday through Friday.