Patient Financial Assistance Program Documents

Patient Financial Assistance Program Documents — Henry Ford Health

Program Policy

• English Program Policy
• Spanish Program Policy

Plain Language Summary

• English Plain Language Summary
• Spanish Plain Language Summary

Program Application

• English Application
• Spanish Application

Amounts Generally Billed

• English Amounts Generally Billed
• Spanish Amounts Generally Billed

The following documents related to our policy and eligibility have been translated into many languages for your convenience.

Need help?

• Contact the Financial Assistance Team at (313) 874-7800
• Schedule an in-person appointment by calling (313) 916-4510. Business Office Hours are Monday-Friday 8:30am-5:00pm

Patient Financial Assistance Program Documents – Ascension hospitals and care sites in Southeast Michigan

Program Policy

• English Program Policy
• Spanish Program Policy

Summary - Financial Assistance Policy

• English Plain Language Summary
• Spanish Plain Language Summary

Program Application

• English Application
• Spanish Application

Amounts Generally Billed

• English Amounts Generally Billed
• Spanish Amounts Generally Billed

Billing and Collection Practices

• English Billing and Collection Practices
• Spanish Billing and Collection Practices  

The following documents related to our policy and eligibility have been translated into many languages for your convenience.

• List of Providers Covered by Financial Assistance Policy – All Languages

Need help?

• Contact the Financial Assistance Team at the following locations:
  • St. John, Providence Southfield, Novi, Warren, & Madison Heights: (877) 809-6191
  • River District: (888) 544-7737

Patient Financial Assistance Program Documents – Henry Ford Rochester

Program Policy

• English Program Policy
• Spanish Program Policy

Summary - Financial Assistance Policy

• English Plain Language Summary
• Spanish Plain Language Summary

Program Application

• English Application
• Spanish Application

Amounts Generally Billed

• English Amounts Generally Billed
• Spanish Amounts Generally Billed

Billing and Collection Practices

• English Billing and Collection Practices
• Spanish Billing and Collection Practices

The following documents related to our policy and eligibility have been translated into many languages for your convenience.

• List of Providers Covered by Financial Assistance Policy – All Languages

Need help?

• Contact the Financial Assistance Team at (877) 348-7072.

Patient Financial Assistance Program Documents – Henry Ford Genesys  

Program Policy

• English Program Policy
• Spanish Program Policy

Summary - Financial Assistance Policy

• English Plain Language Summary
• Spanish Plain Language Summary

Program Application

• English Application
• Spanish Application

Amounts Generally Billed

• English Amounts Generally Billed
• Spanish Amounts Generally Billed

Billing and Collection Practices

• English Billing and Collection Practices
• Spanish Billing and Collection Practices

The following documents related to our policy and eligibility have been translated into many languages for your convenience. 

Need help?

• Contact the Financial Assistance Team at (888) 544-7737.