Financial Assistance and Charity Care

UCI Health strives to provide quality patient care that meets high standards for the communities we serve.

This policy demonstrates UCI Health’s commitment to our mission — Discover, Teach, Heal — and our vision by helping to meet the needs of the low-income, uninsured patients and the underinsured patients in our community.

About the Financial Assistance Program (Charity Care)

The Financial Assistance Program, also known as Charity Care, offers emergency and other medically necessary services at low or no cost to the patient. A discount rate is applied automatically at the time of billing to uninsured individuals.

Determination of eligibility for the Financial Assistance Program is made based on review of the completed financial screening form and the receipt of the following documents:

  • Proof of income
  • Assets
  • Liabilities

Generally, patients with family income at or below 200 percent of the federal poverty level will be eligible for a discount of 100 percent.

Patients with family income between 201 percent and 400 percent of the federal poverty level may be eligible for a partial discount based on income level.

If you receive financial assistance under our policy, you will not be charged more for emergency or other medically necessary care than the amount we generally bill patients who have Medicare coverage.

Where to find our financial assistance policy

You may obtain a copy of our Financial Assistance Policy and application in several ways:

  • Download a copy in English ›
  • Pick up a physical copy from the Emergency Department, Patient Financial Services Department, or any location where patient registration occurs.

How to obtain information and assistance

For information regarding our Financial Assistance Program, please contact our Shared Business Office at (833) 353-7700, Monday through Friday from 8:30 a.m. to 4 p.m.

What languages are available?

The Financial Assistance Policy, Financial Screening Form and Plain Language Summary are available in English, Spanish and Vietnamese.

Providers who do not participate in financial assistance

Certain UCI Health physicians, such as those not contracted with the UCI Health Medical Group rendering health care services at UCI Health do not participate with UCI Health’s Financial Assistance Program.

Where to send your application

Return your completed application to:

200 South Manchester Ave., Suite 400
Orange, CA 92868

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