Financial Assistance | Charity Care
EvergreenHealth is committed to extending financial assistance, free or reduced fee care, to qualifying individuals.
If payment of your health care expenses could create a financial hardship for you, our staff will work with you to apply for financial assistance.
Financial counseling is offered through our Patient Financial Services Department. Applications will be processed, and approval will be determined based on specific criteria. Information you provide is confidential and is only reviewed by staff processing your application. If approved, financial obligation to EvergreenHealth will be reduced.
What is Charity Care?
Charity Care is a way to help low income individuals and families pay for medical services. Charity Care is either free care or reduced-price care, depending on your income.
Who is eligible for Charity Care?
EvergreenHealth does not discriminate based on age, race, color, national origin, religion, sex, handicap or disability.
- Individuals and families with incomes within EvergreenHealth’s Poverty Guidelines which are based on the Washington State published poverty guidelines. Please refer to the EvergreenHealth Poverty Guidelines to determine eligibility.
- Individuals who have been screened and determined ineligible for Medicaid or state programs
- Individuals who are not involved in a situation where someone else has a legal responsibility to pay for the costs of medical expenses – for example, an auto accident.
- Individuals who are Washington state residents and are not entering Washington state solely for the purpose of seeking medical care. Exceptions to the Washington state residency requirement in the Charity Care Policy include:
~ all patients who have an emergency medical condition, consistent with applicable federal and state laws and regulations.
~ refugees, asylees and those seeking asylum who possess and can present United States Citizenship and Immigration Services (USCIS) documentation.
What does Charity Care Cover?
Charity Care covers all medically necessary hospital services and services provided by other EvergreenHealth entities depending upon your eligibility. It does not cover transportation costs, elective procedures or package price procedures.
How do I apply?
- Please verify your eligibility by referring to the EvergreenHealth Poverty Guidelines
- Please complete the Charity Care/Financial Assistance Application Form
(All required fields must be filled out in order to be considered for charity)
- Include all supporting documents (pay stubs, checking & savings account statements, etc.)
- Proof of identification
- Sign and date form
- Return the completed form to:
12040 N.E. 128th Street MS#55
Kirkland, WA 98034
If you have questions regarding EvergreenHealth’s Charity Care Program or the Confidential Financial form please contact EvergreenHealth’s Charity Care Line at 425.899.1616.