Apply for financial assistance

For nonprofit hospital bills you genuinely cannot pay. Federal rules require every 501(c)(3) hospital facility to maintain a written financial assistance policy covering emergency and medically necessary care. This letter formally requests that policy and applies under it.

The lever: A nonprofit hospital is required to have a financial assistance policy — this letter asks it to apply the policy it already has.

Fill this letter in →All seven letters

The letter

Bracketed placeholders are the fields you fill in. The generator does the filling and keeps your draft in your browser.

[YOUR FULL NAME]
[YOUR ADDRESS]

[TODAY'S DATE]

[WHO YOU ARE WRITING TO]
[THEIR ADDRESS]

Re: Account [ACCOUNT OR BILL NUMBER] — application for financial assistance
Date of service: [DATE OF SERVICE]

To whom it may concern,

I am writing to request financial assistance for the account above and to ask for a copy of your financial assistance policy, including the application form, the eligibility criteria, and the documentation you require.

My circumstances: [YOUR CIRCUMSTANCES, BRIEFLY]
Household size: [HOUSEHOLD SIZE]

Section 501(r) of the Internal Revenue Code requires each 501(c)(3) hospital facility to establish a written financial assistance policy applying to emergency and other medically necessary care, and to make that policy available on request. I am asking to be considered under that policy.

Please confirm in writing that this application has been received, and place the account on hold while my eligibility is determined. If any documentation is missing, please tell me specifically what is needed and I will provide it promptly.

If I am found ineligible, please tell me in writing why, and what discounted rate or payment terms are available to me instead.

Sincerely,

[YOUR FULL NAME]

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This is a template, not legal advice.

What this letter rests on

After you send it

Day 10Call to confirm the application was received and ask what the review timeline is. Ask specifically whether the account is on hold.
Day 30No decision? Resend by certified mail and ask for the financial counselor or patient advocate by name.
Day 60If denied, ask in writing for the reason and the appeal route — most policies have one, and the denial letter rarely mentions it.

The case tracker turns this schedule into dated reminders for one specific bill, stored in your browser.

Frequently asked questions

Which hospitals must have a financial assistance policy?

Every hospital facility operated by a 501(c)(3) organization, under section 501(r)(4) of the tax code. That is a large share of US hospitals. The policy must cover emergency and other medically necessary care and must be publicly available — the nonprofit-hospital lookup in the charity-care screener helps you check a specific facility.

Do I have to be below the poverty line to qualify?

No — eligibility bands are set by each hospital, and many extend free care and sliding-scale discounts well above the federal poverty level. Because the thresholds are per-policy, this site never promises a specific outcome; the screener shows the bands hospitals commonly use and links you to the actual policy.

Will applying hurt my credit or trigger collections?

This letter asks for the account to be held during review, which is standard practice. Section 501(r)(6) also restricts what a nonprofit hospital may do collections-wise before making reasonable efforts to determine FAP eligibility. Applying is generally protective, not risky.

How much personal detail should I include?

Income, household size, and what changed — nothing more. The template deliberately keeps the circumstances field factual. You will likely be asked for tax returns or pay stubs during the formal application; that is the moment for documents, not this letter.

Everything you type here is computed in your browser. Nothing you enter is stored on a server, sent anywhere, or shared — there is no account, and your balances never leave your device.

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Other situations

Request an itemized bill Dispute a billing error Billed above the cash price

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