WebOne form of personal identification for each family member, including patient, spouse and minor dependents. Acceptable forms of ID include: U.S. driver’s license, passport, social security card, birth certificate, alien registration card or employee ID. Proof of Address as of (date of service/application) _____. WebWhom Can I Contact with Questions About My Bill or Statement? Customer service representatives are available to help you. Please call us at 919-620-4555 (local) or 1-800-782-6945 (toll-free) with any questions or concerns you may have about your bill. Hours are 8:00 am to 5:00 pm Monday, Tuesday, Wednesday, and Friday and 8:00 am to 4:00 pm ...
Medical Expense / Financial Hardship Assistance Program
WebFinancial Assistance Application . Complete this form entirely to help us determine your eligibility for financial assistance. Return the completed form with copies of supporting documents to Carilion Clinic, CASB Suite 625, P.O. Box 40032, Roanoke, VA 24022-0032, or fax to 540-224-5444 or email to . [email protected]. WebComplete DUHS Financial Assistance Application - English - Duke Medicine online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send … newton symbool
Get Duke University Health System Financial Hardship Form
WebDuke University Health System (DUHS) financial assistance is also available for eligible patients based on Federal Poverty guidelines. Download an application in English or … WebNov 3, 2024 · The charity care application form is filled by the one who is eligible for free of cost treatment or for reduced price treatment. Contact Financial Assistance. Learn Spanish. If you would like to discuss financial assistance with your medical bills with a WakeMed Financial Team Member, please call 919-350-8359. WebCall us at 717-231-8989 or 1-877-499-3899 (toll-free) Download the application here (PDF) Request a paper application by writing to us at: UPMC in Central Pa. Attention: Financial Aid Representative PO Box 2353 Harrisburg, PA 17105-2353 Financial counselors are available in person or by phone. newton symbole