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  • Financial assistance
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Financial assistance for UT, ID and NV

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Apply online

If you need help paying for medical care at an Intermountain Health location, you should apply for financial assistance. You can apply online in English and Spanish

Apply in EnglishApply in Spanish
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Mail in your application

You may also print the application form, fill it out, and give the form, along with the appropriate documentation, to an Eligibility Counselor at an Intermountain facility.

Download English ApplicationDownload Spanish Application
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Do you need help paying your bill? Our financial counselors can see if you qualify for financial assistance or discounts, help you make a payment plan or discuss your other options

(866) 415-6556

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 or by writing to Financial Assistance, P.O. Box 30193 Salt Lake City, UY, 4130. 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. For more information, call 866-415-6556 (TTY:888-735-5906).

How do I apply?

You can apply online or by mail. Online applications and mail-in applications are linked above. If you receive (or plan to receive) medical care in an Intermountain hospital and have questions about financial assistance, please call 800-748-9175. If you receive (or plan to receive) medical care in an Intermountain clinic and have questions about financial assistance, call  800-748-4248. If you are interested in payment options, please call 866-665-2636. To apply for financial assistance in person, visit your local hospital or clinic where you receive services.

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.

Full financial assistance policies


Read our full policy about financial assistance.

Español (Spanish) 

Lea en su totalidad nuestra política sobre ayuda financiera.

العربية (Arabic) 

إقرأ بوليصتنا الكاملة حول المساعدة المالية.

汉语/漢語 (Chinese)


Le français (French)

Lisez toute notre politique sur l’assistance financière.

한국어/조선말 (Korean)

재정 보조에 관한 저희의 정책을 자세히 읽어 보시기 바랍니다.

Pу́сский (Russian)

Также ознакомьтесь с нашими правилами о предоставлении финансовой помощи. 

Tiếng Việt (Vietnamese)

Đọc toàn bộ chính sách về hỗ trợ tài chính của chúng tôi.