Sutter Pacific Medical Foundation offers financial assistance to patients who are uninsured or have a low income and may have difficulty paying bills. Patients who submit applications and are approved may be eligible for full or partial relief from charges.
Sutter Pacific's Financial Assistance Program is designed to:
- Provide care to uninsured patients earning up to 400 percent of the Federal Poverty Income Guidelines (FPIG). The FPIG is updated each year in February.
- View the Federal Poverty Income Guidelines
- Provide catastrophic protection to low income uninsured patients by limiting their liability to 30 percent of their annual household income.
To apply for financial assistance, send the following documentation and complete the
Statement of Financial Condition Form.
- Your two most recent paycheck stubs
- Your two most recent bank statements (all accounts)
- Your most recent tax return
Review this letter and checklist. Then, send your completed packet to:
Sutter Physician Services
P.O. Box 22050
Salt Lake City, UT 84122-0050
Patients are encouraged to fax their application and documents to 801-575-1255 to our secure fax line. Copies of Sutter Pacific’s Charity Care Policy are available by calling 877-351-4875 between 8:00 am - 5:00 pm.
Your Confidentiality is Guaranteed
Confidentiality of information and individual dignity will be maintained for anyone who seeks charitable services. The handling of personal health information will meet all HIPAA requirements.