Regions Hospital is committed to meeting the medical needs of our community This commitment includes offering an assistance program for those patients who need medical care but have difficulty managing the related expenses. If you wish to apply for this assistance, please use the Financial Assistance Application Form. Please note that the form must be completed in its entirety in order to process the application. In addition, we require copies of your most recent federal tax returns and copies of your most recent two pay statements. If you are currently receiving disability income, please provide a copy of your most recent award sheet as well as a copy of the most recent tax return. When your application and supporting documentation arrives in Patient Accounting, these will be reviewed by a committee. Eligibility for assistance is based on federal poverty guidelines, size of family, household income and expenses, etc. We expect our patients to pursue all sources of payment for medical expenses before assistance can be granted. You will be notified by mail of the outcome of the application. Thank you for using Regions Hospital for your healthcare needs. Regions Financial Application After completing the Regions Hospital Financial Application mail to:
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