Financial Assistance: Help Paying Your Bill
If your family income is below 400 percent of the Federal Poverty Income Guidelines, you may qualify for financial assistance. Catastrophic medical coverage is also available if you have high medical costs (exceeding 10 percent of your family income). Our Patient Financial Services (PFS) office can determine whether you are eligible once you provide:
- A completed application form and letter
- Documents verifying your income (tax return, pay stubs, or employer salary history)
Your completed Financial Assistance Form and supporting documents should be returned to the PFS office. The PFS staff may contact you to request additional information. If you need assistance completing the form, please call our office. Once the eligibility process is complete, we will mail you a Financial Assistance Notification letting you know whether, and to what extent, you are eligible for financial assistance.
Additional payment options are available for those who do not qualify for financial assistance.
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Patient Financial Services
1-415-925-7070
Email Us -
Phone Hours
Monday – Friday:
7:30 am – 3:00 pm - Online Bill Payment via MyChart
Hospital Bill Complaint Program
The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program. Go to: HospitalBillComplaintProgram.hcai.ca.gov for more information and to file a complaint.
Note: Authority cited: Section 127010, Health and Safety Code. Reference: Section 127410, Health and Safety Code.