Geisinger is committed to providing healthcare to those in need, regardless of their ability to pay, so we offer a generous Financial Assistance Program.
To find out if you are eligible for Geisinger's Financial Assistance Program, print the financial statement application and complete all fields on the form. Use "N/A" if the information does not apply. Applications with missing or incomplete information will be returned to you for the information to be provided, resulting in a delay in processing or possible denial. Upon completion of the form, please review for accuracy and mail with all applicable information outlined below to:
Geisinger Uncompensated Care Services 49-38
100 N. Academy Avenue
Danville, PA 17822-0002
All of the following documents are required, in addition to the completed financial statement, for your application to be processed:
- Most recent federal tax return, including all schedules, is attached and signed by all tax payers on form
- If you filed your taxes electronically, please sign the bottom of the form
- If you are not required to file taxes, you have indicated so on the financial statement
- Copies of the last three (3) months checking and/or savings accounts statements (must include all pages of the statement—summary pages will not be accepted)
- If no savings or checking accounts, you have indicated so on the financial statement
- Proof of income from all sources for all members of the household
- Employed: Copies of the four (4) most recent consecutive pay stubs, or letter from employer on letterhead outlining same information
- Unemployed: If no income exists, a notarized letter stating there is no income from any source
- Unemployment Compensation: Copy of eligibility determination letter, last four (4) pay stubs or copies of bank statement showing deposits
- Social Security/Disability: Copy of current year’s benefit determination letter
- Pension: Copy of pension check, letter or bank statement showing deposits
- Alimony/Child Support: Copy of agreement, letter, check or bank statement showing deposits
- Most recent investment account statements: 401K/403B, IRA, Tax Deferred Annuity, CD, etc.
- Copy of medical assistance denial letter if you are enrolled in Medicare or do not have health insurance (denial must not be older than one year and must include all pages)
- Copy of denial or exemption letter from the Marketplace
- If married and currently separated, proof of separation
If you have questions or need help completing the form, call our Patient Service Call Center at 1-800-640-4206.
The types of proof of income to be returned with the complete financial statement vary. Include all items below that apply to you:
Employed – Copies of the four most recent pay stubs for the income(s) of all members of the household. If this is not available, a letter from your employer on their letterhead outlining the same information is acceptable.
Unemployment Compensation - Copy of the eligibility determination letter must be submitted.
Unemployed - If no income exists, a notarized letter stating there is no income being received from any source is required.
Social Security Recipient – A copy of the current year’s benefit determination letter is acceptable.
Disability Recipient – A copy of the Benefit Determination letter is acceptable.
Pension Recipient - Copy of pension check or a letter from the pension’s source stating the dollar amount of the monthly benefit.
In the event a Medical Assistance application has been submitted recently and rejected, a copy of the rejection letter (in addition to any other previously listed information that may apply) is requested.
Note: Guidelines for Geisinger-Bloomsburg Hospital differ from those of the rest of Geisinger Health System. Geisinger-Bloomsburg Hospital patients should follow the guidelines here (pdf).
If you have any questions or need help completing the statement, contact the Patient Service Call Center at 1-800-468-7201
Financial assistance policy
- Geisinger hospitals and clinics are charitable organizations dedicated to providing care, regardless of ability to pay.
- Your financial circumstances will not affect the care you receive. All patients will be treated with respect and fairness.
- Assistance is available for medically necessary care. Patients may apply for financial assistance at any time during the contiuum of care.
- If you have no health insurance and/or limited financial resources, you may be eligible for free or discounted services. Uninsured patients will be required to apply for Pennsylvania Medical Assistance.
- The amount of financial assistance you receive is determined by Geisinger’s financial assistance guidelines, which are explained in this brochure (pdf).
- Depending on the amount of your bill and your financial circumstances, minimum monthly payments as low as $25 may be accepted, with no interest charged.
- If you do not qualify for financial assistance but believe you have special circumstances, you can request that your case be reviewed by a Geisinger Business Service Coordinator/Financial Counselor.
- If you apply for financial assistance, you must provide us with all information necessary to apply for other financial resources that may be available to you, such as Medicaid or Medicare.