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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 hospital bill as well as patients who have coverage with an insurance carrier but are unable to pay their portion of the hospital 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​​ appli​cation.

    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: 
      Baylor Scott & White Health 
      ATTN: Financial Assistance Program Application
      2001 Bryan St., Suite 2600 
      Dallas, Texas 75201​​

Eligibility Criteria

Basic Guidelines

All patients may apply for financial assistance at any time during the continuum of care or after care is received. However, eligibility for financial assistance only applies to all emergency and other medically necessary care. Each patient's situation will be evaluated according to relevant circumstances, such as income, assets or other resources available to the patient or patient's family when determining the ability to pay the outstanding patient account balance.

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: The financial assistance offered under this policy does not apply to physician or other professional fees billed separately from the hospital fees. Baylor Scott & White reserves the right to further limit the services covered by this policy.

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:

  1. Household Size1
  2. 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.

Length of Eligibility

Once financial assistance has been approved, it is effective for all outstanding patient accounts and for all services provided within six (6) months after the assistance application is signed by the patient or responsible party or the Baylor Scott & White employee (“Date of Completion”). Financial assistance may be extended for an additional six (6) months with affirmation of the patient's income or estimated income and household size. All patients must reapply after the initial twelve (12) month period is over. If a patient qualified under presumptive eligibility, financial assistance will only apply to the date(s) of service on the patient account balance being evaluated. Eligibility will not apply to accounts for future dates of service.

Financial Assistance Classifications

The level of financial assistance is based on two classifications:

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 1/25/2016

Financially Indigent Classification
100 percent if patient's yearly household income is less than or equal to 200 percent of the Federal Poverty Level
Number of Household Up to 200 percent of Federal Poverty Level
1 23,760
2 32,040
3 40,320
4 48,600
5 56,880
6 65,160
7 73,460
8 81,780

Medically Indigent

"Medically Indigent" means a patient whose medical or hospital bills from all related or unrelated 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 are eligible for a 95 percent discount as set forth in Schedule B (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 4 and Yearly Household Income of $85,000 (between 200 - 500 percent of FPG) is eligible for a financial assistance discount of 95 percent if the patient's total outstanding bills, after all third-party payments, exceeds 5 percent of the Yearly Household Income. Assuming the patient's account balance is $10,000 (which is greater than 5 percent of the Yearly Household Income), the patient is eligible for a 95 percent discount ($9,500). The patient's remaining obligation would be 5 percent ($500).

Schedule B

Based on Federal Poverty Guidelines Issued 1/25/2016

Medically Indigent Classification
95 percent discount if patient's yearly household income is less than or equal to 500 percent of Federal Poverty Level and current hospital bills are greater than or equal to 5 percent of patient's yearly household income
Number of Household Up to 500 percent of Federal Poverty Level
1 59,400
2 80,100
3 100,800
4 121,500
5 142,200
6 162,900
7 183,650
8 204,450

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