If you are uninsured or under-insured with a family income of up to 200% of the Federal Poverty Level, you may be eligible to receive medical services at no cost to you.
If you are uninsured or underinsured with an annual family income between 200% and 500% of the Federal Poverty level, you will be charged the amount generally billed (AGB), which is an amount set under federal law that reflects the amounts that would have been paid by private health insurers and Medicare (including co-pays and deductibles) for the medically necessary services that you received.
If you are eligible for financial assistance under our Financial Assistance Policy you will not be required to pay more than the “amount generally billed” described above. If you qualify, you may also request an interest-free extended payment plan.
You will never be required to make advance payment or other payment arrangements in order to receive emergency hospital services.
Free copies of the Financial Assistance Policy and financial assistance application forms are available online (see links below) and in the reception areas of each physician’s office. Copies of these documents can also be mailed to you upon request if you call customer services at the telephone numbers listed below.
Dignity Health Customer Service is available to answer questions, provide information about our financial assistance policy, and help guide you through the financial assistance application process.
Dignity Health Medical Group Arizona Patient Billing Department 866.621.7272 | Customer Service 602.406.3860.
For answers to your questions and assistance with the process, call our Customer Service team at 866.621.7272.
How to apply
If you are not eligible for a government program, you may qualify for Dignity Health's needs-based Financial Assistance program.
Step one Fill out Dignity Health's Financial Assistance Application (English) or Dignity Health's Financial Assistance Application (Spanish)
Step two Collect additional documents outlined in the application.
Step three Mail your application and documents to the address noted on the application.