Financial Assistance Services

Please fill out the application below to ensure that we have all the information for us to work together.

We at Bingham Healthcare understand that medical care can be costly at times. We have a Financial Assistance program to ease this burden. Please take a moment to review the eligibility requirements below and the items you will be required to submit to determine if you qualify for our financial assistance program.

Eligibility Requirements

  1. Household income must be below 200 percent of the federal poverty guidelines. Income below 150 percent of the FPG will be considered for financial assistance. Income between 150 percent and 200 percent will be considered for lower monthly payments.
  1. The excess of income versus necessary monthly expenses must not exceed the acceptable monthly payment for the account.
  1. Non-disabled adult household members must be working at least part time.
  1. Liquid assets cannot exceed 3 months’ worth of living expenses.
  1. Services must be medically necessary.
  1. All other applicable programs must be exhausted.

For a full explanation of eligibility requirements, click here. 

If you have you any questions about your eligibility for our Financial Assistance program, please call our Patient Financial Counselors. This is a free service and they can be reached between 8 am and 5 pm, Monday to Friday, at: (208) 782-3969.

Financial Application

If you qualify for our Financial Assistance program, complete one of the following application:

Required Documents with Application

Along with your application, you will need to submit the following items to determine your eligibility for the program:

  1. Last 2 years tax returns
  2. Last 2 months bank statements (checking and savings)
  3. 2 most recent pay stubs for all adult household members (if applicable)
  4. Copies of all current monthly bills
  5. Any other documents that would be helpful to support your financial situation (ex: letter from your Dr. supporting working limitations, proof of job search)

 Please submit the application and required documentation to:

Bingham Memorial Patient Financial Advocates

98 Poplar St.

Blackfoot ID 83221

Please call us with any questions at: (208) 782-3969.

Thank you for your interest in our Financial Assistance program.

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