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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 60 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

University of Michigan Health-West’s financial assistance program may be available if you are:

  • Uninsured
  • Insured but cannot afford your out-of-pocket costs
  • Insured but receiving services that are not a benefit of your insurance plan

Eligibility for assistance is determined by:

  • Income and assets
  • Michigan residence
  • Medical necessity

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: