Financial Assistance

Required information when submitting an application:

• Proof of income, such as a copy of your federal income tax return or three current copies of your pay stubs.
• If you are claiming no income, you must have a signed letter of support from the organization or person providing you with living expenses.
• If someone in your household has an open account at the hospital and you want this account to be considered for financial assistance, provide their social security number on the form.
• If you were denied for Medical Assistance within the last 90 days, attach a copy of the denial to your application.

Forms:

• Meritus Financial Assistance Policy Overview
• Application for Financial Assistance
• Haga clic aquí para descargar la solicitud de asistencia financiera en español.
• Click here to read the plain language summary
• Haga clic aquí para leer el resumen en lenguaje sencillo
• Click here to read our Credit and Collections Policy
• Click here for a full list of Meritus Providers

You will be notified in writing of the decision regarding this application within 30 days of the submission of your application. If you have any questions or concerns about your application, please contact us at 301-790-8247.