Financial Aid for Your Medical Group Bill
At Ascension hospitals and clinics, patients receive necessary medical care, regardless of their ability to pay. Services are provided without regard to culture, age, gender, sexual orientation, spiritual beliefs, socioeconomic status, language or disability. Trained financial counselors are available to discuss individual needs. We will review your eligibility for financial assistance and assist you in making payment arrangements.
If you feel you need financial assistance, please print and complete the financial assistance application form below:
Our mailing address for completed forms:
Ascension Medical Group
P.O. Box 80278
Indianapolis IN 46240
Additional income, asset and expense information may be requested upon review of the completed financial assistance application.
Financial counselors are available Monday through Friday 8 am – 4:30 pm. For additional assistance please contact a counselor associated to the location where services were performed.
Contact Us
Hours
Monday-Friday
8 am-4:30 pm
Ascension Medical Group
844-931-1162
For additional information about the financial assistance policy or an application form, view the documents below:
Financial Assistance Application
- Financial Assistance Application (PDF)
- Aplicación de Asistencia Financiera (PDF)
- Đơn Xin Trợ Giúp Tài Chánh (PDF)
Financial Assistance Policies
- Financial Assistance Policy (PDF)
- Política de Asistencia Financiera (PDF)
- Chính sách hỗ trợ tài chính (PDF)
Summaries of the Financial Assistance Policy
- Summary of Financial Assistance Policy (PDF)
- Resumen de la Política de Asistencia Financiera (PDF)
- Tóm Lược Chính Sách Trợ Giúp Tài Chánh (PDF)
Lists of Providers Covered by the Financial Assistance Policy
- Providers covered by the financial assistance policy (PDF)
- Proveedores cubiertos por la póliza de asistencia financiera (PDF)
- Nhà cung cấp bao phủ bởi các chính sách hỗ trợ tài chính (PDF)