Financial Assistance Plain Language Summary

Financial Assistance Offered

UW Medicine offers financial assistance, under its Financial Assistance Policy, to eligible patients who are unable to pay for emergency or other medically necessary care. UW Medicine provides financial assistance for any patient/guarantor whose gross family income is up to 400% of the Federal Poverty Level (FPL) and adjusted for family size after any third-party coverage has been exhausted. For facility and/or professional services at Airlift Northwest, Harborview Medical Center, UW Medical Center, UW Physicians, UW Medicine Primary Care, and Valley Medical Center:

• 0% - 300% of the FPL for a 100% financial assistance discount

For facility services only with discharge dates on or after July 1, 2022 at Harborview Medical Center, UW Medical Center, and Valley Medical Center:

• 301% - 350% of the FPL for a 75% financial assistance discount
• 351% - 400% of the FPL for a 50% financial assistance discount

For Valley Medical Center, an individual who is eligible for financial assistance cannot be charged more than the amounts generally billed for emergency or other medically necessary care.

Eligibility Requirements and Assistance Offered

Eligibility for financial assistance is based on many factors including the nature of the condition and care required, insurance coverage or other sources of payment, income, family size, and any special considerations the patient or provider would like to have considered.

Patients seeking financial assistance must comply with the Financial Assistance application process. This includes submitting the patient’s W-2 statement, current pay stubs, bank statements or last year’s income tax return, and completing the application process for all available sources of assistance, including Washington state subsidized care.

How to Apply for Assistance

The patient or any person involved in the care of the patient, including a family member or provider, can express financial concerns. The patient or responsible party will then be encouraged to complete a financial assistance application. To qualify for financial assistance, an application can be submitted at any time prior to an account receiving a court judgment.

What is Eligible for Assistance

Financial assistance is limited to medical care provided at a UW Medicine location by UW medical personnel. Expenses such as travel, food, lodging, and durable medical equipment are not covered under the Financial Assistance policy. Prescriptions may be covered for patients up to 300% of the FPL for a 100% financial assistance discount if written by a UW Medicine provider and filled at a UW Medicine pharmacy (if available).

Where to Obtain Copies, Submit Documents and Contact Information

UW Medicine Financial Assistance Policy, Financial Assistance Application, Plain Language Summary, and Billing & Collection Policies are available free of charge. These documents can be accessed in multiple languages online, by phone or in person. Documents are online to download or print at uwmedicine.org/financialassistance or valleymed.org/financialassistance. You can ask for your copy in person or by phone from the location where you are seeking care.

For the Financial Assistance application and supporting documents in English, you can now utilize MyChart (except Airlift Northwest) to submit your documents based on your care location. For all other application submissions continue to submit by mail, fax, or in person. Any information submitted for consideration will be treated as protected health information under the Health Insurance Portability and Accountability Act (HIPAA).