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Page 1 of 10Holy Cross Health: Patient Financial Assistance Owner/Dept: Julie Keese, VP Revenue Mgmt/ Office of Chief Financial OfficerDate approved: 10/27/2022Approved by: Anne Gillis (RHM Chief
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How to fill out patient financial assistance

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How to fill out patient financial assistance

01
Obtain the patient financial assistance application form from the healthcare facility.
02
Fill out the form completely and accurately, providing all requested information.
03
Gather any necessary documents such as proof of income or medical bills to support your application.
04
Submit the completed application along with any supporting documents to the designated department at the healthcare facility.
05
Wait for a response from the facility regarding the status of your application.

Who needs patient financial assistance?

01
Patients who are facing financial hardship and struggling to afford their medical expenses.
02
Patients who do not have health insurance or have high out-of-pocket costs.
03
Patients with chronic conditions or serious illnesses that require expensive treatments.
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Patient financial assistance is a program designed to help patients unable to pay for medical services due to financial hardship. It provides support in the form of grants, reduced fees, or payment plans.
Patients who require financial support for medical services typically need to file for patient financial assistance. This can include individuals with low income, uninsured patients, or those experiencing financial difficulties.
To fill out patient financial assistance, patients should obtain an application form from the healthcare provider or hospital. They will need to provide personal information, income details, and any supporting documentation that verifies their financial situation.
The purpose of patient financial assistance is to reduce the financial burden on patients, ensuring they receive necessary medical care without the overwhelming stress of costs they cannot afford.
The information that must be reported typically includes personal identification, income levels, family size, and any medical expenses. Documentation may also be required to support the application.
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