Gundersen Health System provides medically necessary care regardless of ability to pay. We can provide financial assistance for medical expenses that you or your family accumulate at any of our facilities. If you believe you may be eligible for Financial Assistance we encourage you to apply. Financial assistance application forms can be completed at no charge in MyChart or can be downloaded below.
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Please look for the clinic or hospital location where you receive your care.
In order to qualify for potential financial assistance through Gundersen Health System for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy (English)
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public Access to documents
- Tsab Cai Txog Kev Pab Nyiaj Them Nqi (Hmong)
- Política de asistencia financiera (Spanish)
- Kaalmada Maaliyadda (Somali)
- Pomoc finansowa (Polish)
- Self-Pay Billing & Collection Policy (English)
- Tsab Cai Txog Kev Xa Nqi Rau Cov Nws Them Nws Ntiag Tug & Kev Tsib Nqi (Hmong)
- Política de facturación y cobranza a particulares (Spanish)
- Siyaasadda Biilasha Qofka Bixiyo iyo Aruurinta (Somali)
- Fakturowanie płatności własnych pacjentów i pobieranie należności (Polish)
Gundersen Health System
Customer Financial Services
PO Box 4444
La Crosse, WI 54602-4444
If you have any questions, call us at (608) 775-8660 or (800) 362-9567, ext. 58660 from 7:30 a.m. to 5:30 p.m., Monday through Friday.
Gundersen Boscobel Area Hospital and Clinics includes the hospital and medical clinics in Boscobel, Fennimore and Muscoda.
Financial Assistance
In order to qualify for potential financial assistance through Gundersen Boscobel Area Hospital and Clinics for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public access to documents
Gundersen Boscobel Area Hospital and Clinics
Customer Financial Services
205 Parker Street
Boscobel WI 53805
If you have any questions, call us at (608) 375-4112.
Gundersen Moundview Hospital and Clinics includes the Hospital and Clinics in Friendship and Westfield.
Financial Assistance
In order to qualify for potential financial assistance through Gundersen Moundview Hospital and Clinics for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public Access to documents
Gundersen Moundview Hospital and Clinics
Financial Services
402 W. Lake Street, Friendship, WI 53934
If you have any questions, call us at (608) 339-3331.
Gundersen St. Joseph's Hospital and Clinics includes the Hospital and Clinics in Hillsboro, Wonewoc and Elroy.
Financial Assistance
In order to qualify for potential financial assistance through Gundersen St. Joseph's Area Hospital and Clinics for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Payment Options
- Payment Options (Hmong)
- Payment Options (Spanish)
- Financial Assistance Policy
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public access to documents
- Financial Assistance Policy and Appendix(Spanish)
- Financial Assistance Policy and Appendix (Hmong)
Gundersen St. Joseph's Area Hospital and Clinics
Customer Financial Services
400 Water Avenue, Hillsboro, WI 54634
If you have any questions, call us at (608) 489-8198.
Gundersen St. Elizabeth's Hospital and Clinics includes the Hospital and Clinics in Wabasha and Alma.
Financial Assistance
In order to qualify for potential financial assistance through Gundersen St. Elizabeth's Hospital and Clinics for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public Access to documents
Gundersen St. Elizabeth's Hospital and Clinics
Patient Accounts Department
1200 Grant Boulevard West, Wabasha, MN 55981
If you have any questions, call us at (651) 565-5545
Gundersen Palmer Hospital and Clinics includes the Hospital and Clinics in West Union, Postville and Fayette.
Financial Assistance
In order to qualify for potential financial assistance for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Plain Language Summary (English)
- Financial Assistance Policy (English)
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public Access to documents
- Self-Pay Billing & Collection Policy (English)
Gundersen Palmer Lutheran Health Center
112 Jefferson Street
West Union, IA 52175
If you have any questions, call us at (563) 422-3811 from 7:30 a.m. to 4:30 p.m., Monday through Friday.
Gundersen Tri-County Hospital and Clinics includes the Hospital and Clinics in Whitehall, Blair and Independence.
Financial Assistance
In order to qualify for potential financial assistance for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy
- Appendix 2: Discount chart based on income and asset thresholds, and the uninsured discount rate
- Appendix 3: Covered providers and departments
- Appendix 4: Amounts Generally Billed (AGB) Percentage
- Appendix 5: Public Access to documents
- Política de asistencia financiera (Spanish)
Gundersen Tri-County Hospital and Clinics
18601 Lincoln Street
Whitehall, WI 54773
If you have any questions, call us at (715) 538-4361 ext. 64207.
In order to qualify for potential financial assistance through Gundersen Health System for medical bills, you will need to complete the Financial Assistance Application and include the items on the checklist.
- Financial Assistance Application (English)
- Daim Ntawv Thov Kev Pab Nyiaj (Hmong)
- Aplicación para Asistencia Financiera (Spanish)
- Arjiga Kaalmada Maalyadda (Somali)
- Winiosek O Pomoc Finansowa (Polish)
- Financial Assistance Policy (English)
- Tsab Cai Txog Kev Pab Nyiaj Them Nqi (Hmong)
- Política de asistencia financiera (Spanish)
- Kaalmada Maaliyadda (Somali)
- Pomoc finansowa (Polish)
- Self-Pay Billing & Collection Policy (English)
- Tsab Cai Txog Kev Xa Nqi Rau Cov Nws Them Nws Ntiag Tug & Kev Tsib Nqi (Hmong)
- Política de facturación y cobranza a particulares (Spanish)
- Siyaasadda Biilasha Qofka Bixiyo iyo Aruurinta (Somali)
- Fakturowanie płatności własnych pacjentów i pobieranie należności (Polish)
Gundersen Health System
Customer Financial Services
PO Box 4444
La Crosse, WI 54602-4444
If you have any questions, call us at (608) 775-8660 or (800) 362-9567, ext. 58660 from 7:30 a.m. to 5:30 p.m., Monday through Friday.