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Sanford health financial assistance form 2026

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Sanford Health offers a financial assistance program to help patients who may face financial hardship in paying for healthcare services. Patients are required to complete an application detailing their financial situation and provide supporting documents, such as tax returns and proof of income. If eligible, part or all of their account balance may be forgiven. The application process includes a review period of 30 days, with options for appeals if circumstances change. Contact information for further inquiries is provided.

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Click ‘Get Form’ to open the Sanford Health Financial Assistance Form in our platform.
Begin by filling out the Demographics section. Enter your name, date of birth, and Social Security number. If applicable, include your spouse's information as well.
Indicate your marital status and provide your address along with contact numbers for both yourself and your spouse.
List all dependents under 18 living in your household, including their names and dates of birth.
In the Income section, input monthly gross income for yourself and your spouse across various categories such as employment, Social Security, and other income sources. Ensure you provide proof of all income.
Specify how much of your Sanford bill you can pay per month.
Read the Assignment of Rights carefully. Sign and date the application to certify that all information is accurate.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (51 Votes)
2013	4.3 Satisfied (36 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What benefits do Orlando Health team members get?

Disability and Life Insurance Orlando Health provides group term life insurance, short-term disability, and long-term disability at no cost to our team members. Life insurance options for self, spouse and children are available.

What does Sanford financial assistance cover?

application will cover charges for emergency and medically necessary care provided at a Sanford facility and billed through our centralized Patient Financial Services. Sanford may consider charges for services provided after our date of approval for up to six months without requiring a new application to be completed.

What is the phone number for Orlando Health Financial Assistance?

Financial Assistance representatives are available Monday Friday, 8:00 a.m. 4:30 p.m. They can be reached by phone at 321.843. 8955, or by e-mail: FinancialAssistance@orlandohealth.com.

Where can I get financial assistance in Florida?

The Department of Children and Families, Economic Self Sufficiency Program has several programs that can help Florida families. They include Food Assistance, Temporary Cash Assistance, Medicaid and Refugee Assistance. Each of these programs has its own eligibility rules.

Does Orlando Health have financial assistance?

In an effort to meet the communitys healthcare needs, financial assistance is available to patients/guarantors (person that is financially responsible) who have limited or no resources to pay for emergent or medically necessary services rendered at an Orlando Health facility.

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Does Orlando Health offer payment plans?

For Payment arrangements we offer secure and flexible PAYMENT OPTIONS. 12 month, interest free, equal monthly payment plan. Requires a minimum monthly payment of $25. Contact Orlando Health via the information above.

What is the phone number for Sanford Health financial?

Important notice specific to your account. Thank you for choosing Sanford Health. If at any time you have questions regarding your Sanford Health billing statement, please contact our office at (877) 629-2999 or (800) 263-2237.

How much is the Sanford prompt pay discount?

Upon request, prompt pay discounts are available for services if there is no insurance coverage/benefit. Deductible, co-insurance and co-pay amounts do not qualify for a discount. Prompt pay discounts for payment in full of 40% if paid within 30 days, 30% if paid within 60 days or 20% if paid within 90 days.