Patient Financial Services

We know the cost of health care services can be a concern for you, and we’re prepared to help.

Our staff will assist you in understanding what your health insurance will pay and your options to pay the part of the bill you may be responsible for paying. We hope we can ease your concerns and help you focus on your first priority – a prompt return to good health.

KSB offers a number of financial plans, including:

  • a prompt pay discount
  • long term payment plans
  • an uninsured discount
  • charity care
  • bank loan assistance, and more.

Please prepare to fill out this application for processing.

Financial Assistance Available

YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE:  Completing this application will help Katherine Shaw Bethea Hospital to determine if you can receive free or discounted services or other public programs that can help pay for your healthcare.  Please submit this application to the hospital.

IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE.  However, a Social Security Number is required for some public programs, including Medicaid.  Providing a Social Security Number is not required, but will help the hospital determine whether you qualify for any public programs.

Please compete this form and submit it to the Financial Advocate in person, by mail, by electronic mail or by fax to apply for free or discounted care within 60 days following the date of discharge or receipt of outpatient care:

KSB Financial Advocate Services

KSB Lovett Center
101 West First Street
Dixon, IL  61021
Fax:  815-285-5903

Patient acknowledges that he or she has made a good faith effort to provide all information requested in the application to assist he hospital in determining whether the patient is eligible for financial assistance.

Payment Plans

In order to help you manage your healthcare payments, we’ve improved our payment plan options. For example, if you have a bill for $500, you may make monthly payments of $50 for ten months to pay off the bill with no interest.

If your bill is between $100 and $500, your monthly payment is the higher of $20 or 10% of your bill.
If your bill is between $501 and $1,000, your monthly payment is the higher of $50 or 7.5% of your bill.
If your bill is between $1,001 and $2,000, your monthly payment is the higher of $75 or 5% of your bill.
If your bill is between $2,001 and $5,000, your monthly payment is the higher of $100 or 4% of your bill.
If your bill is above $5,000, your monthly payment is 3% of your bill.

Patient Education on Billing Issues

As you may know, there are very specific regulations about billing for health care services. As your health care provider, we are obligated to follow those regulations in how we report services provided to you. Additionally, every insurance plan may have different rules that vary from insurer to insurer and may even vary between plans of the same insurer.

  • All physicians/providers must report services using a variety of codes to tell the insurance company what was done and why.
  • It is not uncommon for patients in the course of a visit to receive management and treatment services for a separate and specific problem, as well as routine or preventative services at the same visit.
  • Both services must be reported to the insurance company and may result in an additional co-payment or charge as per the insurer’s plan rules, which we are obligated to follow.
  • There are many different insurance companies and plans; addressing a problem may trigger a co-payment or additional charges to your account.
  • Your financial responsibility is determined by the rules of your insurance company, which we are obligated to follow.
  • If you have questions, please check with your insurance plan.

We are dedicated to providing the best possible care for you and your family and respecting your time.

Plain Language Summary & KSB’s Financial Policy


If you have questions, please contact the Patient Financial Services Department at 815-285-5900 or send an email to

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