Hospitals and health systems have financial assistance programs that offer free or discounted care to patients based on their financial situation to help make care more affordable.

We welcome you to use this tool to see if you qualify for financial assistance and apply online at your hospitals. You may be able to save thousands of dollars on your hospital bills if you do. Hospital financial assistance programs offer significant discounts to patients based upon family size and financial situation, and even fully employed individuals with health insurance can qualify for these programs.

Debt Dismissal Website: https://debtdismissal.myfa.app/

Please use the navigation buttons in the platform. Do not use the back button on the web browser as your information will not be saved. For security purposes, we do not save your personal information, so you need to complete your application all at once.

Debt Dismissal Employer Code

Have your Debt Dismissal Employer Code ready as it will give you access to the site.

Refer to the Debt Dismissal application guide, ask HR, or contact debtdismissal@scriptsourcing.com if you need this information.

Step 1 -Select Your Hospital

Since each hospital has their own financial assistance program with unique eligibility criteria, the first step is selecting your hospital from the drop-down menu to see if you qualify according to their policy, and to submit your financial assistance application form to their business office.

If your hospital is not listed, select “My Hospital Isn’t Listed…Yet!” enter the information that is being requested, and we will verify that they offer financial assistance, add them to the list, and notify you.

Step 2 – See If You Qualify

After selecting your hospital, the next step is answering the questions to see if you qualify for full or partial medical debt relief from your hospital.

If the results state, “you may qualify for financial assistance” we recommend you go ahead and complete your application online. If the results state, “it does not look like you qualify for financial assistance,” you are still welcome to apply as the hospital may reach out to assist you with additional programs or insurance options available to you.

Step 3 – Online Application

The last step is completing your application for financial assistance to submit it to your hospital for review. Hospitals often require supporting documents along with your application such as proof of income, insurance card pictures, bank statements, etc. to verify your financial situation, and we will give you an opportunity to upload any of those documents that apply to you as a part of the application.

Last year’s W2 form(s)
Last year’s tax return
Past 2 months of pay stubs
Past 2 months of bank statements
Health insurance card, if applicable

Any other relevant income information for your household

You may proceed with submitting your application without these documents; however, the hospital will likely contact you directly for this information after receiving your application.

Confirmation of Submitted Financial Assistance Application Email

A confirmation email will be sent to you within 24-hours. If you do not receive, be sure to check your junk email folder. The hospital should get back to you via a mailed letter within 45 days. If more information is needed, the hospital will contact you directly.

Questions or Need Help

If you have questions or need help using the platform, please contact us at DebtDismissal@scriptsourcing.com, and we would be happy to assist you.