Financial Assistance Qualifications
For Bryan Medical Center, Crete Area Medical Center and Merrick Medical Center patients
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 one bank statement
- A letter of explanation for any documentation you are unable to provide
Patient Financial Services
2300 S. 16th St.
Lincoln, NE 68502
If you have questions, please call 402-481-5791 or 877-577-9277 or email PFS@bryanhealth.org.