Baylor Scott & White Health Financial Assistance Program

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As part of its commitment to serve the community and provide quality medical care to all of our patients, Baylor Scott & White Health provides a Financial Assistance Program to patients who satisfy certain requirements. This includes patients who don't have health insurance and can't pay their bill as well as patients who have coverage with an insurance carrier but are unable to pay their portion of the bill after insurance pays.

Methods for Applying or Obtaining Financial Assistance

If you believe you qualify for financial assistance and have not spoken with a financial counselor or received a discount, then you should complete Baylor Scott & White's Financial Assistance Application through any of the following options:

1. Call us or visit a Baylor Scott & White financial counselor at any one of our hospitals.

To initiate an application, please call customer service anytime Monday to Friday from 8 a.m. to 5 p.m. Additional documentation may be required to complete your application.

North Texas (Dallas-Fort Worth Metroplex)
Toll free number: 1.800.725.0024
Central Texas (Temple/Killeen/Waco, Austin/Round Rock, the Brazos Valley and the Hill Country)
Toll free number: 1.800.994.0371

2. Download and print the paper application.

Please be sure to attach the application along with the appropriate supporting documentation when:

Dropping off your application with a Baylor Scott & White financial counselor at any one of our hospitals
Mailing your application to:
ATTN: Financial Assistance Program Application
301 N. Washington Ave.
Dallas, TX 75246

Eligibility criteria

Eligibility for financial assistance only applies to emergency and other medically necessary care.

Basic Guidelines
Determination of Financial Assistance

Basic Guidelines

Patients may apply for financial assistance from the date a patient is scheduled for service through the 365th day after the first billing statement is provided. However, eligibility for financial assistance only applies to emergency and other medically necessary care. Only United States citizens and residents of the United States are eligible for financial assistance. Financial assistance eligibility for non-emergency, medically necessary care is limited to patients residing in the service area defined in Attachment D of Baylor Scott & White's Financial Assistance policy, which includes all counties covered in BSWH Community Health Needs Assessments and otherwise where BSWH owns or operates licensed hospitals or provider-based clinics, as long as the facility providing the patient’s care is the closest facility (including non-BSWH affiliated facilities) to patient’s residence that can provide such medically necessary care or patient demonstrates that the closest facility cannot or will not provide such care. However, all patients, regardless of residency, will be eligible to qualify for financial assistance for emergency care and for non-emergency, medically necessary care provided after a BSWH facility accepts a transfer from a BSWH facility or a non-BSWH facility. Each eligible patient’s situation will be evaluated according to relevant circumstances, such as income or other resources available to the patient or patient’s family when determining the ability to pay the patient account balance.

When a patient’s circumstances do not satisfy the requirements under the Financial Assistance Eligibility Discount Guidelines or Eligibility Criteria, a patient with unusual mitigating factors may still be able to obtain financial assistance. In these situations, the Financial Assistance Committee will review all available information and make a determination on the patient’s eligibility for financial assistance.

The patient must provide information regarding the patient’s financial status and complete an application to be qualified for assistance. If you do not meet the income limits and cannot pay your bill, Baylor Scott & White offers an extended, interest-free payment plan to those patients.

Please note: Except indicated in the BSWH Provider List (Attachment C) of Baylor Scott & White's Financial Assistance policy, the financial assistance offered under this Policy does not apply to services provided by any physicians or other professionals.

If you received services from a HealthTexas Provider Network (HealthTexas) physician, you may be eligible for Baylor Scott & White's Financial Assistance Program. For more information, please visit HealthTexas' website and read more about HealthTexas' financial assistance policy.

Determination of Financial Assistance

To find out if you qualify, please provide the following information during your application process:

Household Size¹
Yearly Household Income², which must be verified by one or more of the following financial documentation (listed in order of preference):
- Pay check remittance
- W-2
- Wage and Tax Statement
- Individual tax return
- Telephone verification by employer of Patient’s Reported Income
- Social Security payment remittance
- Worker’s compensation payment remittance
- Unemployment insurance payment notice
- Unemployment compensation determination letters
- Proof of participation in governmental assistance programs such as food stamps, County Indigent Health Program (CDIC), Aids to Families with Dependent Children (AFDC), Medicaid, Women, Infants, and Children (WIC), or Temporary Assistance for Needy Families (TANF), TexCare Partnership
- Bank statements
- Response from a credit inquiry
- Or other appropriate indicators of patient's reported income

¹Adults: In calculating the Household Size, include the patient, the patient’s spouse, and any dependents (as defined by the Internal Revenue Code (IRC)).

Minors: In calculating the Household Size, include the patient, the patient’s mother, the patient’s father, dependents of the patient’s mother, and dependents of the patient’s father.

²Adults: If the patient is an adult, “Yearly Household Income” means the sum of the total yearly gross income or estimated yearly income of the patient and the patient’s spouse.

Minors: If the patient is a minor, "Yearly Household Income" means the sum of the total yearly gross income or estimated yearly income of the patient, the patient's mother and the patient's father.

Financial assistance classifications

The level of financial assistance is based on two classifications:

Financially Indigent
Medically Indigent

Financially Indigent

"Financially Indigent" means a patient whose Yearly Household Income is less than or equal to 200 percent of the Federal Poverty Guidelines ("FPG"). These Financially Indigent patients are eligible for a 100 percent discount on outstanding patient account balances based on Schedule A (see below) of the Financial Assistance Eligibility Discount Guidelines (Attachment B) of Baylor Scott & White's Financial Assistance policy.

Example: A patient with a Household Size of 3 and Yearly Household Income of $36,620 is eligible for a financial assistance discount of 100 percent.

Schedule A

Based on Federal Poverty Guidelines Issued 1/15/2020

Financially Indigent Classification
Patient's yearly income must be equal to or less than the following:
Number of Household	200%
1	25,520
2	34,480
3	43,440
4	52,400
5	61,360
6	70,320
7	79,280
8	88,240
Patient Responsibility	0% of Balance Due

Medically Indigent

"Medically Indigent" means a patient whose medical or hospital bills from all BSWH related providers, after payment by all third parties, exceed 5 percent of his or her Yearly Household Income, whose Yearly Household Income is greater than 200 percent but less than or equal to 500 percent of the FPG and who is unable to pay the outstanding patient account balance. These Medically Indigent patients will owe the lesser of the patient’s account balance or 10% of the patient’s gross charges not to exceed the calculated AGB amount as described in Section 4 of Baylor Scott & White's Financial Assistance policy.

Example: A patient with a Household Size of 4 and Yearly Household Income of $85,000 (between 200 - 500 percent of FPG) is eligible for a financial assistance discount down to the lesser of the patient’s account balance or 10% of gross charges not to exceed the calculated AGB amount if the patient’s total outstanding bills, after all third-party payments, are equal to or greater than 5% of the Yearly Household Income. Assuming the patient’s gross charges is $50,000 and account balance is $10,000 (which is equal to or greater than 5% of the Yearly Household Income) and the calculated AGB amount is $15,000; the patient’s remaining obligation would be $5,000. Please note, if the patient’s remaining balance is already less than 10% of gross charges or the calculated AGB amount, the patient will receive no additional fee reduction and will be responsible for paying the remaining balance.

Schedule B

Based on Federal Poverty Guidelines Issued 1/15/2020

Medically Indigent Classification
Balance due must be equal to or greater than 5% of the patient's yearly income for eligibility, and such yearly income must be equal to or less than the following:
Number in Household	Up to 500%
1	63,800
2	86,200
3	108,600
4	131,000
5	153,400
6	175,800
7	198,200
8	220,600
Patient Responsibility	Lesser of patient account balance or 10% of gross charges not to exceed AGB*

*AGB is defined as "Amounts Generally Billed" to individuals with insurance as stated in Section 4 of the Financial Assistance Policy

Financial assistance documents

View Financial Assistance Documents for all Baylor Scott & White Health Controlled Affiliates.

Documents are available in English, Español, Русский, 한국어, Tiếng Việt, العربية, Français and 简体中文.

Contact us

By Phone

Monday through Friday from 8 a.m. to 5 p.m.

Central Texas

Tollfree: 1.800.994.0371

North Texas

Local: 214.820.3151

Tollfree: 1.800.725.0024

By Mail

Send us your completed application along with the supporting documents to:

Baylor Scott & White Health
Attn: Financial Assistance Application
301 N. Washington Ave
Dallas, Texas 75246

Online

Have questions about patient billing or financial assistance? We're here to help. Use this form to submit your question to one of our customer service representatives.

Complete the Form

In Person

Visit your financial counselor and learn more about your financial assistance options.

Location Information