Financial Assistance
Financial assistance is available for patients who receive medically necessary services and meet the eligibility requirements under the policy. If eligible for financial assistance, patients will receive a discount of 100% or free care. The financial assistance program does not cover elective services.
Am I eligible?
To qualify for financial assistance, all of the following conditions must be met:
- The patient must be uninsured or, in certain circumstances, have limited insurance coverage.
- The patient must be unable to access other programs that would cover medical expenses.
- The patient’s annual family income must be no more than 300% of the Federal Poverty Guidelines for the current year.
- The patient must not have substantial cash assets.
- The patient must not have declined health insurance through an employer.
- The patient must not be ineligible for government sponsored coverage because of noncompliance with requirements.
- The service must be considered medically necessary (generally defined as urgent or emergent).
- The patient must reside within a 25-mile radius of the facility where services are rendered.
- The completed application and all supporting documentation must be submitted to the Patient Account Services department, during the applicable time period, for review and approval. Download a list of required supporting documentation in English or Spanish.
How do I apply?
Applications for financial assistance are available in English and Spanish and can be obtained in several ways:
- Download it from here. English version | Spanish version
- Call Customer Service toll-free at 877-250-9871 and request a copy. One will be mailed at no charge.
- Call the toll-free customer service number on the front of your statement and request a copy. One will be mailed at no charge.
- Email a request for an application to [email protected].
- Visit the facility where the exam was performed and request one.