Get Upmc Com Financial Assistance

UPMC offers financial assistance for medical care to eligible individuals and families. This guide provides step-by-step instructions to help you successfully complete the Upmc Com Financial Assistance online application form.

Follow the steps to complete the financial assistance application.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Fill out the patient information section, including the patient's name, date of birth, and social security number. Ensure accuracy as this information is vital for processing.
3. Provide your address, including city, state, zip code, and county, along with your daytime and alternate phone numbers for contact.
4. Indicate the name of the patient’s employer and the spouse’s employer, if applicable.
5. Check the services you are requesting financial assistance for. Specify if the services were provided by UPMC Hospitals, Physician Services, or Cancer Centers.
6. If you have received a bill, enter the account or patient ID number. Also, indicate whether you currently have health insurance and whether you have applied for Medical Assistance in the past six months.
7. List all members of your household, including their relationship to the patient and their ages, to ensure completeness of the application.
8. Document the monthly household income from all sources for each member listed. This should include wages, self-employment, social security, pensions, and other income types.
9. Attach all necessary proof of income documents as specified in the documentation checklist. Make sure to include photocopies, not originals.
10. Complete the disclaimer section to verify that the information provided is accurate and acknowledges the confidentiality of the information.
11. Sign the application form authorizing UPMC to verify the information and confirming your understanding of the eligibility criteria.
12. Once the application is completed, save your changes, and consider downloading, printing, or sharing the form as needed before submission.

Complete your UPMC financial assistance application online today to access the support you need.