Financial Assistance Application
If you do not have insurance, you can speak with one of our Customer Service Representatives about payment terms and financial assistance by calling 1 (866) 665-2636. We may be able to make payment plan arrangements and help you secure Medicaid, Supplemental Security Income (SSI) and other benefits for which you are eligible. We also offer other discounts that may be applicable to you your specific situation.
Please complete the financial assistance form, provide all supplemental information and mail your completed application to:
PFS SCL Health
500 Eldorado Blvd., Bldg. 6, Suite 6300,
Broomfield, CO 80021
Once we have received your completed application our Financial Counselors will review your application and inform you of the decision or if they require any additional information.
Download the Financial Assistance Application »
St Marys Hospital Charity required documents 3