Applying for Financial Assistance

We’re Ready to Help

If you cannot afford to pay your hospital or doctor bill, we are ready to help. UPMC’s Financial Assistance Program may be able to assist with expenses for medical care, including UPMC hospital and physician services.

You can fill out a single UPMC Financial Assistance Application form for any of these services.

If you need the application in a non-English language, you can either:

• Call 1-800-371-8359 (option 2) to request an application in a specific language.
• View and download the necessary forms on this page.

If you need the Financial Assistance Application form in a large print version, you can find it on this page as well along with other important financial assistance documents.

Based on your financial need, either reduced payments or free care may be available for these services. UPMC staff will determine if you are eligible for free or discounted health care services by looking at your income and family size. We also may help you set up a payment plan for your UPMC bills. This allows you to make payments within your means.

Please contact UPMC if you require assistance completing the Medical Assistance or Financial Assistance form. Our financial specialists are available to assist you with this process.

You may be eligible for some type of insurance benefits (such as worker’s compensation, automobile insurance, and Medical Assistance). You should explore these options before you can receive financial assistance from UPMC. We can help direct you to the appropriate resources.

Applicants for financial assistance are treated with dignity and respect. We respect your privacy, and all of your information will remain confidential. See UPMC’s Notice of Privacy Practices.

How Do I Apply?

UPMC encourages patients to apply for financial assistance if they believe that they are unable to pay all or part of their UPMC bill.

1. Complete the UPMC Financial Assistance Application form (formulario de Solicitud de Asistencia Financiera).
2. Attach supporting documents, listed on the application, to prove your income.
3. Mail your completed application and necessary documents to:

UPMC Financial Assistance

Quantum Building

2 Hot Metal St.

Pittsburgh, PA 15203

When should I Apply?

• You should apply for financial assistance as early as possible during your medical care. However, you may apply during or after your treatment.
• You may reapply if your financial situation changes.

How do I check the status of an application?

Call 1-800-371-8359 option 2 to check on the status of your application. Please allow 2 to 3 weeks for processing and mailing time.

How do I know if I'm approved?

You will receive written confirmation in the mail.

Where can I learn more?

You can get more information about UPMC’s Financial Assistance Program in several ways:

• At the hospital or physician's office: Request a Financial Assistance Application form from your case manager, at the front desk in the hospital’s registration area, or at your doctor’s office.
• 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.
• By appointment: If you need assistance with completing the application form and would like to schedule an appointment, please call our office at 1-800-371-8359 option 2.

Determination of Assistance Amount

In determining a reasonable and fair level of assistance, UPMC applies a sliding scale.

If a patient's income is below 400 percent of the federal poverty guidelines, the patient may receive some form of Financial Assistance.

If a patient's income is at or below 250 percent of the federal poverty guidelines:

• The patient is eligible for 100 percent financial assistance.
• The fees for UPMC services are completely waived.

If a patient's income is between 251 and 400 percent of the federal poverty guidelines and they are uninsured:

• The patient responsibility will be reduced to the current amount generally billed (AGB)

UPMC will not charge an eligible individual for emergency or other medically necessary services more than the amount generally billed (AGB) to individuals who have insurance covering such care.

In some cases, UPMC may recognize other financial or medical conditions that warrant Financial Assistance. If a patient's income falls outside the guidelines listed above, please contact UPMC's Financial Assistance Department at 1-800-371-8359  option 2 in order to review the circumstances. In any case, UPMC staff may be able to help establish a payment plan that helps patients pay their balance over time.

Exclusions

While UPMC's Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to:

• Cosmetic services
• Transplant-related services
• Bariatric-related services
• Elective reproductive services
• Acupuncture
• Private duty nursing
• Dental services
• Services deemed noncovered by Medicare
• Other services, at UPMC's discretion

Financial Assistance is not typically available for:

• Insurance copayments
• People who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals

In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.

Large Print Financial Documents

• Billing and Collections Policy (PDF)
• Financial Assistance Application Form (PDF)
• Financial Assistance Process Policy (PDF)
• Plain Language Summary of Financial Assistance Policy (PDF)

Translated Financial Documents