PLEASE NOTE
In the event of an emergency you should
always seek immediate medical attention at
the nearest hospital emergency department.
Boston Medical Center
Financial Assistance
Program
TO APPLY YOU WILL NEED
PROOF OF HOUSEHOLD INCOME
For every working adult household member
Such as
• Two recent pay stubs
• Income tax return and schedule
C (if self employed)
A PICTURE ID
For every adult household member
Such as
• Drivers license or other government
issued ID with photo
• Draft record of military card
• Student ID
• Passport photo
CITIZENSHIP VERIFICATION REQUIRED
For all U.S. Citizens in the household.
Please provide one of the following for each
household member
• Birth certicate
• Passport
• Certied hospital record
• Naturalization Certicate
IMMIGRATION STATUS
For non-citizens, who wish to apply for medical
assistance other than Limited MassHealth
• Passport/Visa
• Legal permanent resident card
• Naturalization certicate
ASSET INFORMATION
If over 65 years old
Including bank statements, life insurance,
value of property, and vehicles.
Ask about other forms of identication
or citizenship verication of none of the
above listed are available.
PATIENT QUICK REFERENCE GUIDE
FOR ASSISTANCE WITH APPLYING
FOR HEALTH INSURANCE
You may call 617.414.5155 or email
patnoutreach@BMC.org to schedule an
appointment to complete an application
with a Patient Financial Counselor.
If you are uncertain about your eligibility for
a particular program or whether a particular
medical service will be covered by a program,
please contact that program’s service
number, listed below.
MASSHEALTH
1.800.841.2900
HEALTH CONNECTOR
1.877.623.6765
SNAP FOODSTAMPS
1.877.382.2363
FINANCIAL ASSISTANCE
PROGRAM INFORMATION
The mission of Boston Medical Center (the
“Hospital”) in partnership with its licensed Community
Health Centers, is to provide consistent, high quality,
accessible services to all in need of medically necessary
care, regardless of ability to pay. Its vision is to improve
the health of the people of Boston and its surrounding
communities in a nancially responsible manner.
The Hospital will help uninsured and underinsured
Massachusetts residents apply for health coverage
through public assistance programs (including
MassHealth, the premium assistance payment
program operated by the Health Connector,
the Children’s Medical Security Program, the
Health Safety Net, and Medical Hardship) or
the Hospital’s nancial assistance program.
Hospital employees will work with individuals
to apply to appropriate programs.
WHO IS ELIGIBLE?
Low-income uninsured and underinsured patients
who are Massachusetts residents and meet income
qualications are eligible for nancial assistance.
The nancial assistance programs are determined
by reviewing, among other items, an individual’s
household income, assets, family size, expenses,
medical needs, and state of residence. If eligible,
some patients will not be required to pay for
services; others may be asked to make partial
payments. A Massachusetts resident of any income
may qualify for Medical Hardship through the
Health Safety Net if certain medical expenses have
so depleted his or her income that he or she is
unable to pay for health services.
HOW TO APPLY
The Hospital’s Financial Assistance Policy, Billing
and Collections Policy, and the Plain Language
Summary are available to all patients in English,
Spanish, Haitian Creole, Chinese, Vietnamese,
Portuguese, Arabic, French, and Russian. The
Hospital’s Financial Assistance Policy application
and instructions are available to all patients
in English and Spanish. Assistance in completing
the application in other languages is available
through MassHealth’s interpretive services at
1.800.841.2900 or BMC’s Financial Counseling
Oce at 617.414.5155. More information about the
Hospital’s nancial assistance program, including the
application form and instructions, is available on the
Hospital’s website:
BMC.org/services/patient-nancial-
assistance-program
and at the locations and phone numbers below.
In any patient registration area
within the Hospital
By calling the Financial Counseling
Department at 617.414.5155
Making a written request
to the address below:
Boston Medical Center
Attention: Financial Counseling Ofce
840 Harrison Ave
Boston, MA 02118
By calling MassHealth’s interpretive
services at 800.841.2900
1.
2.
3.
4.
For more information about the
Hospital’s nancial assistance program,
including application and instruction
translation assistance, please contact
the nancial counseling ofce at the
locations and phone number listed
to the right (1-3) or MassHealth for
questions specic to the application
and instructions (4).
