How to apply for Hospital Financial Assistance (Salem Health West Valley Hospital) — Polk

Who it's for

Salem Health, which runs West Valley Hospital in Dallas, offers free and discounted care to eligible patients based on family size and income, even if they have health insurance. Salem Health also gives a 47% discount to patients without health insurance and a 100% discount on balances greater than 20% of gross family income. Call a financial counselor at 503-562-4357 for a phone screening or paper forms.

What you'll need

• Completed financial assistance application
• Current year federal tax return (all pages and schedules), or an IRS non-filing verification letter
• Proof of other income, such as 3 months of pay stubs or a Social Security or pension award letter

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Salem Health West Valley Hospital) — Polk. I'd like to know whether I may qualify, what documents I need, and whether I can apply online, by mail, by phone, or in person. I understand I may need completed financial assistance application, current year federal tax return (all pages and schedules), or an IRS non-filing verification letter, proof of other income, such as 3 months of pay stubs or a Social Security or pension award letter — is anything else required? What is the best next step?"

Tip: have a pen ready, ask for the person's name, and write down any case or reference number they give you.

Renewals

annual (reapply per policy)