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How to use or fill out Fillable Online Patient Financial Assistance Application - Hill
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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Enter your name, account number, address, date of birth, city, state, zip code, and telephone number. Ensure all fields are completed accurately.
Indicate the number of persons in your household and confirm your citizenship status by selecting 'Yes' or 'No'. If you select 'No', be prepared to upload a photocopy of your Legal Resident Card.
In the 'Product Information' section, check the box next to the product type that applies to you. If you currently have a device, answer accordingly.
Finally, review the 'Release and Certification' section. Read through the certification statement carefully before signing and dating the application at the bottom.
Start using our platform today for free to complete your application seamlessly!
Fill out Fillable Online Patient Financial Assistance Application - Hill online It's free
By phone: Talk with a financial specialist or request a Financial Assistance Application form by calling UPMC Financial Assistance Department toll-free at 1-800-371-8359 option 2.
Who is eligible for charity care in PA?
Patients can receive charity care if they have a family income below 300% of the Federal Poverty Level. Financial assistance means receiving care at a discounted rate.
What is DHS financial assistance?
Financial assistance is the transfer to a non-federal recipient anything of value for a public purpose, and at DHS includes grants, cooperative agreements, training, loans, direct payments, and flood insurance.
Should I apply for hospital financial assistance?
Whether your income qualifies you for free care, discounts, or large bill relief, its always worth asking about your options. If you or someone you know is facing a medical bill they cant afford, start by: Searching for the hospitals financial assistance policy.
How to apply for PA financial aid?
To be considered for a PA State Grant, you must fill out the FAFSA. If you are a first-time applicant, you must also complete the PA State Grant Form (SGF). Most renewal students will not have to complete the SGF, but some may need to.
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DSS Contact Information. Please refer to the contact information below for general assistance: All case-specific inquiries: DSS OneNumber at 718-557-1399.
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