Financial Assistance

You must meet certain requirements to be eligible for financial assistance. These are shown in the table below:

*We may evaluate patients for eligibility retrospectively based on criteria not listed above. 

Method 1 or 3 (Traditional or Presumptive): If you have an annual income less than or equal to 250% of the federal poverty level, you may be eligible for a 100% discount. If you have an annual income from 251% to 400% of the federal poverty level, you may qualify for a partial discount.

Method 2 (Catastrophic): If you meet criteria for Eligibility Method 2, your qualifying medical debt may be reduced to 30% of your household income.

Patients who qualify for financial assistance will not be charged more than the Amount Generally Billed (AGB) for emergency and other medically necessary care and not more than the total charges for all other medical care. The AGB Percentage is calculated by dividing the sum of all Medicare fee-for-service and private health insurers that have paid claims to the Henry Ford Health Facility during a 12-month period, by the sum of the associated gross charges for those claims.

Uninsured patients not meeting financial assistance criteria under this policy or other available financial assistance programs offered by Henry Ford Health will be charged for the service based on the uninsured discount rate.

To apply for financial assistance, you must complete a Patient Financial Assistance Application and provide supporting documents. You have up to 240 days after you receive your first bill to apply. After Henry Ford Health receives your completed application, you will be provided with a decision in writing within 30 days. Here are three ways that you can apply for assistance:

1. MyChart: If you are not a MyChart user, please follow these quick steps to sign up for a MyChart account. Once you are signed up or if you’re already a MyChart user, login and navigate over to the Billing tab within the top menu and select the Financial Assistance drop down. On this page, you can begin filling out the financial assistance application online. When filling out the application, be sure to upload any supporting documentation.
2. Download the application: We offer this application in multiple languages. Once you have completed filling out the application by hand and you’ve added it’s supporting documentation, please mail the application to the facility where your care was received. 
3. Mailed Application: If you are unable to apply using one of the methods above, please contact our CBO Customer Service Department at (313) 874-7800 to a request a copy of the application to be sent via postal mail. Once you receive the application, fill it out and include any supporting documentation. Once complete, mail the application to the facility where your care was received. Refer to the table below for mailing address information.

Documentation

When applying for financial assistance using any method listed above, required documentation may include:

• Federal Income Tax Return for the most recent tax year (Form 1040), including all applicable schedules
• Most recent Wage and Tax Statements (Form W-2) and/or Miscellaneous Income (Form 1099)
• Recent copy of the last 2 months of pay stubs with year-to-date earnings for each member of the household or a statement from the employer verifying gross wages
• Proof of other income (i.e. rental property, etc.)
• Recent copy of the last 2 months of bank statement of checking/savings accounts
• Copy of valid Michigan driver’s license or Michigan state identification card
• If applicable, a denial response from Medicaid, Healthy Michigan or Marketplace, and/or COBRA documentation
• Personal statement of financial need from the patient

Henry Ford staff are available at each location to provide information about financial assistance and a copy of a free application:

Uninsured Patients

For qualifying uninsured patients with incomes less than 400% of the Federal Poverty Level (FPL), patient responsibility is adjusted to the percentage of the Medicare allowable amount based on the table below:

Qualifying uninsured patients with incomes below 250% are given a 100% discount.

Insured Patients

For qualifying insured patients with incomes less than 400% of FPL, patient responsibility is discounted based on the table below

Doctors and other providers who participate

If you qualify for financial assistance, then all eligible hospital and provider charges will be assessed for a discount. Many providers may participate in your care, but only charges billed by the following providers may be eligible for assistance.

• All Henry Ford Medical Group providers
• All providers employed by:
  
  • Henry Ford Allegiance Health
  • Henry Ford Macomb Hospital
  • Henry Ford West Bloomfield Hospital
  • Henry Ford Wyandotte Hospital
• Providers contracted and billed by Henry Ford Health for their services

There are providers that may have offices within Henry Ford Health locations or that may provide services within Henry Ford Health facilities who are not part of the above listed groups. This may include services such as labs, radiology interpretations, etc. These providers may not provide financial assistance, and you may receive a separate bill from them.

If you are unsure if your provider is part of the above covered groups, please contact your provider’s office.

Temporary food assistance/ Healthcare for eligible low-income families and individuals is available from the U.S. Department of Agriculture. Use MI Bridges to apply for assistance, check your eligibility status and manage your account online.

Henry Ford has financial counselors who can help find out if you qualify for Medicaid or other local, state and federal help. If you have not been screened for Medicaid in the past 30 days, please call your local Michigan Department of Human Services office for a Medicaid review. You can also apply at MIBridges.

Amounts Generally Billed (AGB) means the amounts generally billed for emergency or other medically necessary care to individuals who have insurance covering such care.

Henry Ford Health calculates the amounts generally billed (AGB) percentage using the “look-back” method. AGB is calculated by dividing the sum of all Medicare fee-for-service and private health insurers that have paid claims to the Henry Ford Health Facility during a 12-month period, by the sum of the associated gross charges for those claims, all in accordance with IRS Reg. Sec. 1.501(r)-5(b)(3). The AGB percentages will be updated annually.

See the current AGB rate by location.