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Dignity health financial assistance application

Dignity health financial assistance form 2025

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The document is a Financial Assistance Application from Dignity Health, requiring personal and financial information from patients seeking financial aid for medical services. It outlines necessary documentation to demonstrate financial hardship, including proof of identity, current address verification, income proof, and details about household members. The application emphasizes the importance of accurate information and consent for credit checks, along with instructions for submission.

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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.

Is dignity health the same as mercy?

Mercy Medical Group, a service of Dignity Health Medical Foundation, is a multi-specialty group of more than 328 physicians and 800 Dignity Health employees providing service to thousands of patients in the Sacramento area and its affiliated local Dignity Health hospitals (Mercy General Hospital, Mercy San Juan Medical

Which items are required components of a financial assistance policy?

The core elements of a board-approved financial assistance policy include eligibility criteria, an application process, and nonpayment collection activities. These components help target assistance to those in need while maintaining the organizations financial integrity.

What is a fap in insurance?

The Financial Assistance Policy (also commonly referred to as the FAP) incorporates the following principles: Uninsured individuals who qualify for Financial Assistance are never expected to pay more than the Amount Generally Billed (AGB) for Emergency or other Medically Necessary Care.

What is the meaning of financial assistance?

Federal financial assistance is authorized by statute with specific authority to transfer money, property in lieu of money, or other direct assistance to eligible recipients to support or stimulate a public purpose.

What is the new name for dignity health?

In February 2019, Dignity Health merged with Catholic Health Initiatives, becoming CommonSpirit Health.

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Does Dignity Health do payment plans?

If you are worried that you may not be able to pay your hospital bill, Dignity Health offers discounted care, interest-free payment plans, or free care depending on your financial circumstances and the care you received.

What is a financial assistance policy?

Financial assistance includes free or discounted health services provided to persons who meet the organizations criteria for financial assistance and are unable to pay for all or a portion of the services.