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Patient Financial Assistance

Bridging the gap for patients in need


Patients may apply for Financial Assistance before, during, or after treatment. Download and print the application and instructions here. You also can get one by visiting Patient Financial Services or by calling Customer Service. See our frequently asked questions for more information.

Applications must include income verification in order to be evaluated.

You do not have to provide a social security number to apply for financial assistance. If you provide us with your Social Security number it will help speed up processing of your application. Social Security numbers are used to verify information provided to us. If you do not have a Social Security number, please mark "not applicable" or "NA."

Consideration of an application occurs when the application with income information is received by 亚搏app官方网站 in accordance with the 亚搏app官方网站 Financial Assistance Policy and Financial Assistance Procedure. The financial assistance allowance structure is based on Federal Poverty Guidelines adjusted for family size and location, which are available on the U.S. Department of Health & Human Services website.

Financial assistance from 亚搏app官方网站 is secondary to financial resources available to the patient, including, but not limited to: insurance, third-party liability, government benefits, support from community agencies, and/or personal resources.

Financial Assistance is not granted to patients who do not cooperate with efforts to determine eligibility for government or other insurance programs. Patients who reside outside 亚搏app官方网站’s service area are not eligible for Financial Assistance unless the patient requires emergent services while visiting in 亚搏app官方网站’s service area.

Financial Assistance is granted only for medically necessary evidenced-based care or for urgent or emergent services. Consideration may be given for preventive screening on a case-by-case basis.

For complete information about Financial Assistance, click here.

Send applications for financial assistance to:

亚搏app官方网站
PO Box 748632
Los Angeles, CA 90074-8632

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