Patient Financial Assistance Program
The Providence Financial Assistance Program is designed to assist patients who need health care services that have limited income levels. The program offers discounts on both previous and future health care services. Some services are restricted from consideration under this program (see Frequently Asked Questions). You can download the Providence Financial Assistance Program Application by clicking on the following link, or contact the representative at 248-849-4145.
Frequently Asked Questions:
What is the Providence Financial Assistance Program?
The Providence Financial Assistance Program is designed to provide financial assistance to our patients needing help paying for their incurred medical expenses.
Who is covered?
To qualify you must:
- complete a Providence Financial Assistance Application and provide all necessary documentation
- have an annual household income that falls within 200% of the Federal the Federal Poverty Guidelines
- not be eligible for Medicaid
- not have, or be eligible for, health insurance
- have services which are ordered by a Providence Hospital employed physician or participating specialist, and provided within the Providence Hospital and Medical Centers healthcare network.
Children and pregnant women are rarely eligible for this program due to other available state and county programs.
What services are not covered?
- insurance co-pays and deductibles
- cosmetic procedures
- infertility treatments
- services that would be covered by insurance in another healthcare network
- personal items, such as television and telephone charges incurred during an inpatient stay
- over the counter pharmaceutical items
- patients who are not residents within our service area (some exceptions may apply)
- Services approved at other SJHS facility without reapplication
Who will provide services?
Providence Hospital employed physicians and participating specialists.
How much does the Providence Financial Assistance Program cost?
There is no coverage cost associated with this program. If eligible, the patient may be responsible for a co-pay.
How can I apply?
Patients need only fill out a short Providence Financial Assistance Application. Submit the application with proof of household income, previous years tax returns, current bank statements, and, if requested, a copy of a Medicaid denial.Click on this link for an application form that you can print out and fill in: Application Form
Note: This application is in PDF format and requires Adobe Acrobat 
Applications are also available from any site at Providence Hospital or by calling 248-746-3092 or 800-878-2455.
