Financial Assistance

If you are unable to pay your hospital bill for medically necessary care, you may qualify for financial assistance. The Financial Assistance Policy provides free care to those individuals who require care needed to treat or manage illness, injury, or disability, and who meet specific criteria. The Financial Assistance Policy only includes services performed at ROSH. If a Financial Assistance Application is received, individuals may be eligible for free care. ROSH does not calculate amounts generally billed (AGB) as an eligible patient does not receive a bill.

Who can apply?

All patients who received medical care from ROSH are eligible to apply for financial assistance. The Financial Assistance Policy provides free care to those who:

In rare cases, ROSH also provides discounted or free care to individuals who are faced with medical bills that are large enough to threaten financial survival. When applying for this type of assistance, individuals will be required to provide information about their income and assets. The CEO of ROSH will make any recommendations for discounted or free care in these cases.

How to Apply

You may obtain a copy of our Financial Assistance Policy and Application Form by clicking on the links below.  Paper copies of the policy and application are available at any location where patient registration occurs. They are also available in our billing office.

Financial Assistance Policy

Application Form

Translations Available

Spanish Financial Assistance Policy

Russian Financial Assistance Policy

Gujarati Financial Assistance Policy

Italian Financial Assistance Policy

German Financial Assistance Policy

Chinese Financial Assistance Policy


Who can I contact if I want to request a free copy by mail, have any questions, or need assistance completing an application?

For Patients

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