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Patient Financial Assistance
The physicians and staff at NDHC understand that some patients have limited resources to pay for services received at our practice. Recognizing this, we have developed a charitable assistance program to help those in financial need with the payment of medical bills. NDHC has developed this application process to verify true need for this financial program. This application will require some time to complete, as NDHC must gather enough information to make a fair and accurate determination of your eligibility for this program.
Acceptable forms of verification of income include:
- Current state and federal tax documents
- Two or more current paycheck stubs
- Social Security Benefit letter (available through the local Social Security office)
- Unemployment benefit letter (available at Job Services)
- Other documentation verifying the applicant's gross incomes
- Letter denying unemployment benefits
Acceptable forms of verification of no income include:
- College students must include their college ID, class schedule, and a financial aid letter
- Brief letter from an individual familiar with the applicant's circumstances. The letter must include the signature, valid telephone number and the address of the individual.
- Termination notice or letter from applicant's former employer stating when his/her employment ended. The notice/letter must include the signature, valid telephone number and the address of the individual.
- Copy of applicant's monthly bank statement, if he/she is living on savings.
- Other documentation indicating the applicant does not have household income.
Denials for assistance from North Dakota Medical Assistance, Health Steps and the Caring Program for Children should be included in the documentation, if applicable.
