Financial assistance for CO, MT and WY

Caring for those who can’t afford care is part of our mission, and we offer financial assistance to those who qualify. Eligibility is based on family size and gross annual household income and is available to those whose income falls within 500% of the current Federal Poverty Guidelines (updated annually). Individuals who exceed 500% of the Federal Poverty Guidelines will be reviewed for qualifying for and for medical hardship. Those in need of emergency care will never be denied treatment or care if they do not have insurance or are unable to pay.

The documents below are available in eight languages. They will help you understand the process, file an application and learn about our financial assistance policy.

Hospital Discounts for Uninsured Patients

Uninsured hospital patients who do not qualify for other assistance programs (such as Medicaid) receive an automatic discount on their bill. For more information, contact the hospital where you received care.

For our Colorado residents, you can learn more about Hospital Discounted Care (HDC)

Our financial assistance policy

When those who live in our communities need care, financial concerns should not prevent them from receiving treatment. Intermountain Health is committed to providing medically necessary care by offering financial assistance to individuals that qualify.

Intermountain Health offers financial assistance for patients who receive medical care provided in Intermountain clinics and hospitals. The program is for most medical care that a medical provider decides is needed. Intermountain’s Financial Assistance Program only applies to bills with Intermountain Health hospital, clinics, and some healthcare providers employed by Intermountain. Those in need of emergency care will never be denied treatment or care if they do not have insurance or are unable to pay.

Financial Assistance is determined on income and household size.
People eligible for financial assistance will not be charged more for emergency or other medically necessary care than the amounts generally billed to insured people.

Amounts Generally Billed (AGB) – The amounts generally billed for emergency or other medically necessary care to individuals who have insurance covering such care. Information regarding AGB percentages and calculations may be obtained in writing and free of charge by sending a request to Peaks_Financialassistanceapps@imail.org or by writing to Financial Assistance, 500 Eldorado Blvd. Suite 4300, Broomfield, CO 80021. AGB is calculated using the “Look Back method” in accordance with 501R federal regulations.

Intermountain Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Call 866-877-4325 for more information.

How do I apply?

Application forms and information are listed below in several languages. If you receive (or plan to receive) medical care in an Intermountain hospital or Intermountain clinic and are interested in payment options, call 866-665-2636. To apply for financial assistance in person, visit your local hospital or clinic where you receive services.

Apply for financial assistance

The information below will help you understand the process, file an application and learn about our financial assistance policy.

In English

To learn more about our financial assistance, start by reading our financial assistance brochure. It will answer many of your questions.

Please fill out the financial assistance form, provide required supplemental information and mail your completed application to: