If you need help paying for medical care at an Intermountain Healthcare facility, you should apply for financial assistance. Applications are available in English and Spanish. If needed, Financial Assistance Representatives will help you complete the 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.

  • To apply for Financial Assistance in person visit your local hospital or clinic where you receive services.

How to Qualify

After patients provide information about household income, household size, expenses, and other personal circumstances, a cost of care compatible with the patient's ability to pay is determined.

Intermountain hospitals use an evaluative process that considers an individual's family income and family size, and total amount of medical bills. Individuals whose family income falls below 250% of the Federal Poverty Guidelines may qualify for full assistance, minus a nominal patient responsibility per episode of care. The evaluative process extends to 500% of Federal Poverty Guidelines. The estimated ability to pay model attempts to determine what portion, if any, of an individual's income may be available to go towards paying for medical debt. As the sliding scale increases, more of an individual's income is potentially available to pay for medical services.

Financial assistance is available only to residents of Utah and certain parts of Idaho for non-emergent or non-urgent medical care. Residence is defined as living in these areas for three or more months. Extenuating circumstances can be considered.

In addition, individuals with catastrophic medical bills may qualify for assistance. Intermountain hospitals currently define catastrophic assistance as situations where all medical bills (not only Intermountain medical bills) exceed 35% of a family's income.

What to Include With Your Application

Please provide the following for all household members:

  • Your two most recent pay stubs or other proof of income from any source. If you are self-employed or unemployed, provide copies of your last three months of bank statements.
  • Your most recent federal tax return, including all forms included with your return.
  • Your current savings and checking account statements.
  • Medicaid denial letter (if applicable)
  • Any information about your financial situation you want considered.

If you cannot provide these, please explain why on the application form.

What Happens After I Apply?

A representative will review your information and determine if you qualify, and communicate this to you. You may be asked to apply for Medicaid or other programs before you receive financial assistance from Intermountain.

I Qualify, How Much Help Will I Receive?

The amount of financial assistance provided will be based on need. Intermountain considers all information you provide with your application to determine this.

If approved for full financial assistance, you will be asked to pay only a nominal amount based on the type of service you received. If you are unable to pay this, the amount can be waived.

For those qualifying for only partial assistance, you will be responsible to pay a percentage of your household annual gross income based on federal poverty level guidelines.

Help with financial assistance

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 400% of the current Federal Poverty Guidelines (updated annually) 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.

Note: These documents are available as printable (PDF) files using Adobe Acrobat. If you do not already have an Adobe Acrobat Reader, download a free copy now.


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.