Financial Assistance Application - California

Download and Mail

Please download the paper form and mail it, and the required documents, to:

PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395

If you have any questions, please call us at:

855-229-6466
Mon.–Fri. 8 a.m.-5:30 p.m. PT

We will respond to your request via mail within 14 business days of receiving it along with all required documents.

Download our financial assistance policy

Learn about our financial assistance program, what is covered and how to apply for help paying your medical bill.

Provider Listings

Download a list of providers who do and do not participate in financial assistance determination. Choose the hospital where you received or plan to receive care.

NOTE: Providers that do not follow the hospital’s financial assistance policy may have their own financial assistance policies, so please contact the provider directly if you have any questions regarding their policies.