Financial Assistance Program

Financial Assistance Policies

• Financial Assistance Policy - English
• Financial Assistance Policy - Spanish
• Financial Assistance Policy - Portuguese
• Financial Assistance Policy - Haitian Creole
• Participating Physicians - for a list of employed and contracted physicians click here.

Billing and Collections Policies

• Patient Billing and Collections Policy - English
• Patient Billing and Collections Policy - Spanish
• Patient Billing and Collections Policy - Portuguese
• Patient Billing and Collections Policy - Haitian Creole

Please click below for additional information on the financial assistance program:

• Financial Assistance Policy Plain Language Summary (PLS) - English
• Financial Assistance Policy Plan Language Summary (PLS) - Spanish
• Financial Assistance Policy Plan Language Summary (PLS) - Portuguese
• Financial Assistance Policy Plan Language Summary (PLS) - Haitian-Creole

Please click below for our financial assistance program application (Guarantor Financial Statement Application):

• Guarantor Financial Statement Application (GFSA) - English
• Guarantor Financial Statement Application (GFSA) - Haitian/Creole
• Guarantor Financial Statement Application (GFSA) - Portuguese
• Guarantor Financial Statement Application (GFSA) - Spanish