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Trinity Health Finance Policy No.1 AS0017FIS EFFECTIVE DATE: 3/1/2016 POLICY TITLE:Financial Assistance to Patients To be reviewed every three years by: Board of Directors/Executive Leadership Team/CFO

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How to fill out financial assistance to patients

01

Step 1: Gather all necessary financial documents such as income statements, bank statements, and insurance information.

02

Step 2: Contact the healthcare facility or organization that provides financial assistance to patients and inquire about their application process.

03

Step 3: Fill out the application form completely and accurately.

04

Step 4: Attach all required documents to the application form.

05

Step 5: Submit the completed application form and documents to the designated department or address provided by the healthcare facility or organization.

06

Step 6: Wait for a response from the healthcare facility or organization regarding the status of your application.

07

Step 7: If approved, follow any additional instructions provided by the healthcare facility or organization to receive financial assistance.

08

Step 8: If denied, consider contacting other healthcare facilities or organizations that offer financial assistance to patients.

Who needs financial assistance to patients?

01

Patients who are facing financial difficulties due to healthcare expenses.

02

Patients who do not have health insurance coverage or have limited coverage.

03

Patients who have a low income or are unemployed.

04

Patients who require expensive medical treatments or procedures.

05

Patients who have a high amount of medical debt.

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What is financial assistance to patients?

Financial assistance to patients is a program designed to help those who are unable to afford the cost of their medical care.

Who is required to file financial assistance to patients?

Healthcare facilities providing medical services to patients in need are required to offer and file financial assistance to patients.

How to fill out financial assistance to patients?

Patients can fill out financial assistance applications provided by the healthcare facility where they receive medical treatment.

What is the purpose of financial assistance to patients?

The purpose of financial assistance to patients is to ensure that individuals in need can access necessary medical care without facing financial hardship.

What information must be reported on financial assistance to patients?

Financial assistance applications typically require information regarding income, assets, and financial need of the patient.

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