ÈËÆÞÖгöÊÓƵ

If you're having trouble paying the full balance of your bill, we will charge:

• a minimum monthly payment of $75, or
• your total patient balance divided over 12 months (whichever is the greater of the two).

If you are unable to pay the minimum due balance, please contact our customer service department and we will review other financial options with you.

If you are experiencing financial hardship, assistance may be available. Income guidelines apply and are subject to approval. You must document your income.

The patient/guarantor must submit current financial information when they submit their financial assistance application. We may ask you to provide the following information when you apply for financial assistance:

• Financial assistance application
• Letter explaining your current financial status
• Copy of current bank statement
• Copy of last year's tax return
• Copies of paycheck stubs and/or other income from the past two (2) months