U of L Hospital

Quality Care Charity Trust Fund (QCCT)

Requirements for Update My Insurance Information (QCCT) Applications

The Quality Care Charity Trust Fund (QCCT) helps provide hospital care services to economically disadvantaged patients at University Hospital.

To qualify for QCCT you must be a United States citizen living in the state of Kentucky and residing in Jefferson County. Out-of-county trauma, burn, stroke, high risk OB or James Graham Brown Cancer Center patients may still be eligible for a discount on their account.

We must have written verification of your monthly income to determine if you qualify for assistance with your hospital bills. The following are the documentation requirements:

  • If YOU OR YOUR SPOUSE is employed, we need a copy of the last four (4) pay stubs or a written statement from your employer.
  • If YOU OR YOUR SPOUSE receives Social Security, unemployment benefits, veteran’s income, alimony, child support, pensions or any other government benefits, we need proof of the amount(s) you receive monthly, biweekly or weekly in the form of a check copy or letter you received stating the amount of your award.
  • If YOU are a student on financial aid, we need a copy of either the financial aid statement from your student loan application or the school’s verifications of the approved loan and grant amounts. We also need verification of income if employed.
  • If YOU OR YOUR SPOUSE are self‐employed, we need your most recently completed tax forms with all schedules.
  • If YOU OR YOUR SPOUSE are unemployed and do not receive unemployment benefits, we need NOTARIZED statements from TWO people who do not live with you.
  • If YOU are supported financially by someone else, we need a NOTARIZED statement from that individual, also.

IN ALL CASES, we need the Application for Disproportionate Share Hospital Program that lists your dependents. Provide copies of ALL THE SOCIAL SECURITY CARDS listed.

Without income verification we cannot determine if you are eligible for assistance with your hospital bills or process your application. If you cannot afford a Notary Public fee, the hospital offers that service in the Business Office at no charge.

If you have any questions or need copies made of your check stubs or other documentation, this can be done at the University Hospital Business Office. The office is located in the MedCenter One Building at 501 East Broadway in the rear of the building. It is open from 9 a.m. to 4 p.m. Monday through Friday. Staff is available by phone at (502) 562‐3226.

QCCT Requirements