Patients who are unable to pay their hospital bill may qualify for certain financial assistance programs that are available. If you are unable to pay your hospital bill, you should contact our Patient Accounts department at 251-279-1551. We will provide a Financial Disclosure, which you should complete and sign. You need to furnish the requested financial information and supporting documents, which should demonstrate your financial need and support your income, expense, asset and debt situation. All information will be reviewed by our Financial Assistance Committee, and qualification with our financial assistance criteria will be determined. Qualifying patients will be notified of the financial assistance determination and dollar amount, if any.

Assistance Letter.pdf
Financial Disclosure Form.pdf

Please furnish the requested financial information and supporting documents.