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The document is a Financial Assistance Application form for patients seeking financial aid for medical expenses. It outlines the necessary steps to complete the application, including required documentation such as tax returns and income verification. The form collects personal and household information, details about income and assets, and asks about other potential funding sources. Patients are advised to fully complete the application process to be considered for assistance.

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How much do you get for financial assistance in Utah?

How Much Money Will I Receive Household SizeGross IncomeMaximum Cash Assistance Amount 3 $1050 $662.00 4 $1230 $775.00 5 $1400 $882.00 6 $1542 $972.006 more rows

How to write a letter asking for financial assistance for medical bills?

To Whom It May Concern: I am writing to negotiate the above medical bills because I am unable to pay the amount requested. Pursuing me for these bills will force me (and my family) into further financial hardship. This is where you explain your current financial situation and why you are unable to pay.

Is Intermountain owned by the LDS Church?

The Church maintained operations, until 1975, when it donated the then 15-hospital system to the communities it served, and Intermountain Health was formed as we know it today.

How to get help with medical bills in Utah?

If you are interested in payment options, please call 866-665-2636. To apply for financial assistance in person, visit your local hospital or clinic where you receive services. The documents below are available in eight languages.

What is the phone number for IHC financial assistance?

If you dont have PIN number or need help to complete this form please call our Financial Assistance Department at 1-800-442-1128. Please check our website for additional information including Frequently Asked Questions, Plain Language Summary, and our Financial Assistance Policy.

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Who qualifies for financial assistance for medical bills in Utah?

Financial assistance is typically available to individuals and families earning up to 500% of the federal poverty level.

How do I get funding for medical bills?

State social services agencies provide direct assistance to people with limited access to health care. They can offer referrals to local health centers and organizations that may be able to help. If you are eligible for Medicare, you can get help paying for your prescriptions through Medicare Part D.

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How much do you get for financial assistance in Utah?

How to write a letter asking for financial assistance for medical bills?

Is Intermountain owned by the LDS Church?

How to get help with medical bills in Utah?

What is the phone number for IHC financial assistance?

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Who qualifies for financial assistance for medical bills in Utah?

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