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Financial Assistance Program

Qualification for financial assistance is based on household income, assets, expenses and a percentage of established Poverty Guidelines.

For uninsured patients who qualify, this program starts with a 40 percent discount on care at any participating UM Health-West doctor’s office. Some patients may qualify for free care. This includes office visits with a UM Health-West doctor, lab tests, physical therapy and imaging services.

The discount is also available for services at UM Health-West Hospital, but does not apply to fees from physicians, such as a surgeon, emergency room physician, radiologist or anesthesiologist.

Financial Assistance Eligibility

Generally speaking, patients eligible for discounted charges must have family incomes under 250% of the Federal Poverty Guidelines. To be eligible for free care, patients must have family incomes under 175% of the Federal Poverty Guidelines.

Financial assistance may also be available in other limited circumstances, depending on the size of the patient’s medical bills and whether the patient meets certain other criteria for eligibility.

If you have questions about financial assistance eligibility, please call a patient representative at (616) 252-7110 or (800) 968-0051.

Financial Assistance Application

To apply for financial assistance, download and complete the form below. The application is available in multiple languages.

The instructions include a list the documents you will need to submit, including proof of income, assets and expenses. (The copies you send will not be returned.)

Please note: If you are under 21, over 65, disabled, or a child caretaker, you will need to apply for Medicaid. If you do not qualify for Medicaid, a copy of the Medicaid denial should be included with the application.

Download the application: