Financial assistance provided by UNMC Physicians is based upon the U.S. Department of Health and Human Services Income Guidelines. Patients must demonstrate an inability to pay for non-elective, medically necessary services in order to qualify for the program.
To receive assistance, you will need to fill out a financial assistance form as well as provide other financial documents. The form can be filled in electronically (by typing) and then printed and signed, or you may fill it out entirely by hand.
In addition to the form, you must provide:
- Federal Tax Return for the most recent year
- Company Pay Stubs
- Proof of all sources of income
Mail this form and documents to:
UNMC Physicians Administration
988095 Nebraska Medical Center
Omaha, NE 68198-8095
Several questions on the application form will help identify if you are eligible for other financial resources such as Medicaid. If you meet the guidelines for these additional resources, you will be required to apply for assistance through the corresponding organization.