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
844-701-9988
For additional information about the financial assistance policy or an application form, view the documents below:
English
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Spanish
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Arabic
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
German
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Gujarati
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Hindi
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Italian
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
French
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Korean
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Japanese
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Polish
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Russian
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Serbo-Croatian
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Tagalog
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Urdu
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Vietnamese
- Financial Assistance Policy
- Summary - Financial Assistance Policy
- FAP Charity Care Application
- Amount Generally Billed
- Billing and Collection Practices
Covered and Non-Covered Providers