Patient Accounts & Services: Financial Assistance

 

Park Nicollet recognizes the financial hardships healthcare needs can create. If you feel your income is not sufficient to pay for your Park Nicollet services, our financial assistance program may be able to help. To apply for Park Nicollet’s financial assistance program, please complete the Financial Assistance Application (PDF). Para la version en Espanol llene Financial Assistance Application Spanish (PDF).

Park Nicollet’s Patient Financial Services staff can help you apply for our financial assistance program as well as government programs such as Medical Assistance.  For more information, contact Patient Financial Services at 952-993-7672 Monday through Friday 8 A.M. to 6 P.M. or view our How to apply for Park Nicollet’s financial assistance program (PDF) document. Please also view our financial assistance Frequently Asked Questions (PDF). 

For a summary of Park Nicollet’s financial assistance policy, contact Patient Financial Services at 952-993-7672 or view it below:

Park Nicollet Health Services financial assistance policy summary

How to apply

How to apply for Park Nicollet's financial assistance program (PDF):

  • Complete the financial assistance application and provide appropriate income verification(s) and mail to: Park Nicollet Health Services, Patient Financial Services - FA/5050, 3800 Park Nicollet Blvd, St. Louis Park, MN 55416
  • You may also fax your completed financial assistance application and appropriate income verification(s) to Patient Financial Services at 952-993-2770.
  • Appropriate income verification(s) include a copy of your most recent Federal 1040 tax return including all applicable schedules, and/or your benefit letter for Social Security, unemployment or disability benefits.
  • The financial assistance application can be printed from our website at Parknicollet.com/FA or you can obtain a copy by calling Patient Financial Services at 952-993-7672. We are open Monday - Friday from 8 am - 6 pm. The application is available in English and Spanish.
  • Designated staff in Patient Financial Services are available to assist you by phone or in person with completing the application. In person assistance is also available in applying for government programs such as Medical Assistance. You may also contact the Department of Human Services in the county in which you reside or call MNsure at 1-855-366-7873.
  • Contact Patient Financial Services at 952-993-7672 with questions about the application or to find a location where a representative is available to meet with you in person.
  • Before applying for Park Nicollet's financial assistance program, a family must have a minimum balance of $200.
  • If approved for Park Nicollet's financial assistance program, a family will be responsible to pay at least the first $200, after insurance processing. Payment of this balance is required before you request future financial assistance. Payment arrangements are available by contacting Patient Financial Services.

  • Applicants must be Minnesota residents or in our service area for reasons unrelated to their health. 

  • Before applying for our financial assistance program, patients must apply for and fully use any governmental assistance. This requirement is so we conserve these funds for people with no other source of payment.
  • Families who are uninsured for hospital services and qualify for our financial assistance program are eligible for a discount according to our agreement with the Attorney General's Office. In these cases, the family will not be required to pay the first $200 self pay balance for qualifying hospital services if the discount results in a family balance of less than $200. The discount is established at the average contractual discount for Park Nicollet Health Service's largest contract payor. The discount is currently 25.5% of gross charges. 

FAQ

Frequently asked questions about Park Nicollet's financial assistance program (PDF):

1. Is the application for a Government assistance program?

  • No, the application is to determine if you quality for Park Nicollet's financial assistance program. Your eligibility for this program is based on your household income, family size and assets. 
  • Before applying for our financial assistance program, patients must first apply for and fully use any available governmental assistance. This requirement is so we can conserve these funds for people with no other source of payment.
  • If you have applied for a government program, your approval or denial letter for that program needs to be attached to your application.

2. How do I qualify for Park Nicollet's financial assistance program?

  • Park Nicollet will review your completed financial assistance application, required income verifications, assets and family size to determine if you qualify for a discount.
  • Income criteria is based on 275% of the Federal Poverty Guidelines. Applicants may be eligible for partial financial assistance with income up to 385% of the Federal Poverty Guideline. Income levels associated with this guideline are based on family size.
  • Liquid assets in excess of $20,000 are included in the income calculation.

3. How long does it take to process my application for financial assistance?

  • The process takes about 14 days upon receipt of the documents necessary to process your application.

4. Whose income must be included with the application for financial assistance?

  • If you are married, both spouses' incomes must be included with the application. Unless you are legally separated from your spouse, you must include both spouses' income. Proof of legal separation is required.
  • If you are 18 years or older you must send in your own application and the income of the person who claimed you on their taxes.
  • For children under 18 years old, you must send in the income of the person who claimed the child(ren) on their taxes. 

5. Can I apply for financial assistance if I have insurance?

  • Yes. Any discount for which you qualify under the program will be made after we receive payment from your insurance company.

6. Will my services qualify for a financial assistance discount?

  • Not all services are eligible for Park Nicollet's financial assistance program. Some excluded services are elective, not medically necessary or cosmetic services, as well as balances that would be paid by insurance, like Medicare, Medicaid, automobile, worker's compensation or liability insurance.

7. How often do I need to apply for this program?

  • You will need to reapply for assistance for each visit at Park Nicollet Health Services. Please contact us at 952-993-7672 to reapply.