Financial Assistance

You may qualify for partial or full financial assistance through our 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 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 and 1099 forms for the tax year when you were in the hospital. If you did not keep a copy, you can contact the IRS at 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 minor 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 all bank account statements; provide a minimum of two
• A letter of explanation for any documentation you are unable to provide

Patient Financial Services
1600 S. 48th St.
Lincoln, NE 68506

If you have questions, please call 402-481-5791 or 877-577-9277 or email PFS@bryanhealth.org.

• Emergency medical services provided in the emergency room
• Non-elective services for urgent life-threatening conditions
• Other medically necessary services, evaluated on a case-by-case basis

• Charity Care Financial Assistance: The level of assistance provided to patients is based on federal poverty guidelines. If a patient’s income is at or below 200 percent of the federal poverty guidelines, the patient is eligible for 100 percent financial assistance. If a patient’s income is between 201 and 400 percent of the federal poverty guidelines, the patient is eligible for a sliding fee scale reduction in hospital charges
• Uninsured Patient Discount: Contact your hospital providing care to see if they offer an uninsured patient discount
• Please note: Bryan Health patients who do not have insurance are never charged more for services than the amount generally billed to those who have insurance

To apply for financial assistance:

• Complete the financial assistance application (or financial assistance application in Spanish) and include required supporting documentation. Check the location where you received care on the application. You also may obtain a free copy of the financial assistance policy, and financial assistance application form, through the mail by calling a patient financial counselor at 402-481-5791. Spanish translations of these forms also are available.
• Mail your completed application and the required supporting documents to the address listed on the Financial Assistance Application Form (also called Financial Statement).

A complete financial evaluation is required to determine your eligibility for financial assistance. Our financial counselor will work with you to obtain all the required information so that the financial evaluation can be completed. Requests for financial assistance will be processed promptly, and you will be notified in writing of approval/denial within a timely manner upon receipt of a completed application.