Manage your bill at Ascension Saint Agnes in Maryland
If you have trouble paying for healthcare, connect with Ascension Saint Agnes in Baltimore, Maryland to find out how we can help you access care.
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
844-994-0412
For additional information about the financial assistance policy or an application form, view the documents below:
Plain Language Summary of Financial Assistance Policy
- Arabic
- Burmese
- Chinese (Simplified)
- Chinese (Traditional)
- English
- French
- Gujarati
- Italian
- Korean
- Russian
- Spanish
- Tagalog
- Urdu
- Vietnamese
Financial Assistance Policy and Covered Providers
- Arabic
- Burmese
- Chinese (Simplified)
- Chinese (Traditional)
- English
- French
- Gujarati
- Italian
- Korean
- Russian
- Spanish
- Tagalog
- Urdu
- Vietnamese
Billing and Collections Policy
- Arabic
- Burmese
- Chinese (Simplified)
- Chinese (Traditional)
- English
- French
- Gujarati
- Italian
- Korean
- Russian
- Spanish
- Tagalog
- Urdu
- Vietnamese
Amounts Generally Billed
- Arabic
- Burmese
- Chinese (Simplified)
- Chinese (Traditional)
- English
- French
- Gujarati
- Italian
- Korean
- Russian
- Spanish
- Tagalog
- Urdu
- Vietnamese
Application for Assistance