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Ballad health financial assistance application online

Get the Ballad Health Application for Financial Assistance 2025

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The document is an application form for financial assistance from Ballad Health, requiring personal and financial information from the patient and their household. It outlines necessary documentation for eligibility determination based on Federal Poverty Income Guidelines, including tax returns, income statements, and asset details. The form also informs applicants about the suspension of collection actions during the application process and provides contact information for assistance.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (20 Votes)
2020	4.7 Satisfied (59 Votes)
2019	4.6 Satisfied (43 Votes)
2018	4.8 Satisfied (50 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 is the phone number for BMS patient assistance program?

Visit bmspaf.org or call 800-736-0003 for more information about an independent charitable program that provides free medication to eligible, uninsured patients who are experiencing financial hardship.

What is the phone number for the provider relief fund?

How can a healthcare provider find more information on the status of their Provider Relief Fund payment or application? Providers should contact the Provider Support Line at 866-569-3522 (for TTY, dial 711), if they have questions about the status of their payment or application.

How to write a letter to a hospital for financial assistance?

- Briefly introduce yourself and state the purpose of the letter. - Explain your situation and why you need financial support. - Provide any relevant details, such as your financial circumstances, goals, and how the funds will be used. - Thank the recipient for considering your request.

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.

Is Intermountain Healthcare owned by the LDS Church?

While Intermountain Healths heritage is built on the churchs dedication to serving the community, The Church of Jesus Christ of Latter-day Saints has no powers, administrative or otherwise, over the health systems operations.

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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 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. Eight DHS Components manage financial assistance to support the DHS mission.

What is the ballad health benefits package?

Competitive pay and benefits package We provide a generous benefits package for our team members, which includes: A choice of medical, dental and vision insurance packages. 401k program with employer matching. Insurance options for life, disability, short-term and long-term care.