NY Rochester Regional Health Financial Assistance Program Application 2017 free printable template

FINANCIAL ASSISTANCE PROGRAM APPLICATION Patients Name Responsible Party AddressFirstLastMIFirstLastMICityStateStreetPhoneDate of Birth CodeHousehold Size Household InformationPlease list everyone

How to fill out NY Rochester Regional Health Financial Assistance

How to fill out NY Rochester Regional Health Financial Assistance Program

1. Gather necessary documents such as proof of income, tax returns, and identification.
2. Obtain the financial assistance application form from the NY Rochester Regional Health website or hospital admissions.
3. Fill out the application form completely, providing accurate information about your financial situation and household size.
4. Attach all required supporting documents to the application.
5. Submit the application either in person at the hospital’s financial assistance department or via mail to the designated address.
6. Wait for a response regarding the status of your application, which may take a few weeks.

Who needs NY Rochester Regional Health Financial Assistance Program?

1. Individuals and families experiencing financial hardship who require medical care but cannot afford the costs.
2. Patients without insurance or those underinsured who may still face high medical bills.
3. Residents of the Rochester area who meet the income eligibility criteria set by the program.

People Also Ask about

What is a letter of support medical expenses?

A letter of medical necessity is typically written by your healthcare provider and includes your diagnosis and duration of the treatment. It should also include the reason why the treatment, product, or service is needed. A letter of medical necessity does not guarantee that your expense will be approved.

How do I write a letter of financial support for a student?

Be direct about what the letter is for (financial aid) Briefly talk about why the school is a great fit for you and why you need the money in an straightforward and respectful way. Provide concise details regarding your specific financial situation, even if you gave these details in your original application.

How do I write a letter for medical financial aid?

Please notify me immediately as to how you intend to resolve this. My hospital bill from [HOSPITAL NAME] has been sent to you for collection. I believe that I should have been offered and granted financial assistance for the medical services that I received at [HOSPITAL NAME] on [INSERT DATE(S) OF SERVICES].

What is Rochester Regional Health customer service line?

To voice a compliment or concern, please call the "Speak Up We Care Patient Hotline" at (585) 922-5465 and select Option 3 Monday through Friday 8 am - 5 pm.

What is Rochester Regional billing number?

If you are making multiple payments, you will need to submit a separate payment for each bill. PLEASE NOTE: If paying a bill with a Canadian postal code, please contact us at (585) 922-1900 or toll-free (866) 209-0949, Monday - Friday: 8 am - 5 pm to make the payment.

Who is Rochester Regional Health affiliated with?

Rochester Regional Health Key peopleRichard "Chip" Davis, Ph.D. (CEO)SubsidiariesInterVol, GRIPA, ElderOne, ACM Medical LaboratoriesAffiliationsCleveland Clinic, Roswell Park Comprehensive Cancer Center, and Rochester Institute of TechnologyRevenue (2016)$2.97 Billion USDStaff (2022)19,000+ Employees16 more rows

How does charity care work in NC?

The Charity Care Program insures that all eligible individuals receive medically necessary care at participating UNC Health Care entities regardless of their ability to pay. The program is available for patients with a household income of at or below 250% of the Federal Poverty Guideline for their family size.

What is the phone number for Rochester Regional Benefits?

From career advancements and opportunities to benefits that can make a difference for you and your family! Call Rochester Regional Health Human Resources at (585) 922-1100.

How to write a financial hardship letter for medical bills?

I am writing this letter to request a settlement of my remaining balance due to the financial hardship that I am currently facing. While receiving care at your hospital, I incurred expenses totaling $15,000. Without any insurance, I was left to cover the whole bill.

What does UNC charity care cover?

Charity Care covers only services deemed "medically necessary" by Medicare, Medicaid, or industry standards. All medically necessary services will be considered Category 1 unless approved as Category 2, 3 or 4 in the Financial Assistance Exceptions Table (Appendix A).

What is the phone number for Rochester Regional Health Billing Department?

If you are making multiple payments, you will need to submit a separate payment for each bill. PLEASE NOTE: If paying a bill with a Canadian postal code, please contact us at (585) 922-1900 or toll-free (866) 209-0949, Monday - Friday: 8 am - 5 pm to make the payment.

What is Rochester Regional Health billing number?

If you are making multiple payments, you will need to submit a separate payment for each bill. PLEASE NOTE: If paying a bill with a Canadian postal code, please contact us at (585) 922-1900 or toll-free (866) 209-0949, Monday - Friday: 8 am - 5 pm to make the payment.

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What is NY Rochester Regional Health Financial Assistance Program?

The NY Rochester Regional Health Financial Assistance Program is designed to provide financial support to eligible patients who are unable to pay for necessary medical services due to financial hardships.

Who is required to file NY Rochester Regional Health Financial Assistance Program?

Individuals who are seeking financial assistance for medical services received at Rochester Regional Health facilities and who demonstrate financial need are required to file for the program.

How to fill out NY Rochester Regional Health Financial Assistance Program?

To fill out the NY Rochester Regional Health Financial Assistance Program application, individuals should obtain the application form from the Rochester Regional Health website or facility, complete it with required financial information, and submit it along with any necessary documentation that supports their request for assistance.

What is the purpose of NY Rochester Regional Health Financial Assistance Program?

The purpose of the NY Rochester Regional Health Financial Assistance Program is to ensure that individuals have access to necessary health care services even when they encounter financial barriers to payment.

What information must be reported on NY Rochester Regional Health Financial Assistance Program?

Applicants must report information such as their income, household size, any financial assets, employment status, and details about outstanding medical bills when completing the NY Rochester Regional Health Financial Assistance Program application.