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Financial Assistance Qualifications

You may qualify for partial or full financial assistance through the Bryan Medical Center financial assistance program.

If you are unable to pay for health care services and do not qualify for Federal or State medical assistance programs, please complete the Bryan Medical Center Financial Assistance Application and return it with all the required proof of income listed below.

We must receive all the items below, or an explanation of why an item(s) cannot be provided, in order to determine a discount for your services.

Please provide the following items:

  • Financial Assistance Application and all information listed on the application.
  • Your Federal Income Tax Return, including all W-2 forms for the current tax year. If you did not keep a copy, you can contact the IRS at 1-800-829-0922 to request a free transcript of your tax return. If you did not file taxes, you must explain why you didn’t file.
  • Proof of income for the patient, spouse and /or all parents of a child. Proof of income can be copies of pay stubs, a copy of an unemployment check, a copy of a disability check, a copy of the Social Security Award Letter and/or a copy of a pension letter.
  • A copy of one bank statement.
  • A letter of explanation for any documentation you are unable to provide.


Please provide the application and all required documentation to our office within two weeks of your hospital visit.

Please mail to: Bryan Medical Center, Patient Financial Services, 2221 S. 17th St., Suite 402, Lincoln, NE 68502

If you have questions, please call 402-481-5791 or 877-577-9277.

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