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Fairview Charity Care program

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Getting help paying your hospital bills

The Charity Care program covers charges for most Fairview hospitals. You may qualify if your income is at or below 275 percent of the Federal Poverty Guidelines (see chart below).

Before applying for the Charity Care program, you may be asked to first apply for help with the county or state. If you currently have no coverage and are a Minnesota resident, please visit the MNsure website at www.mnsure.org or call 1-855-366-7873. If you are not a Minnesota resident, visit your state's health care reform website. If you have coverage and are not sure if you're eligible for additional coverage through the Affordable Care Act, contact our office at 612-672-6724.

Services covered
The Fairview Charity Care program covers charges for most Fairview hospital-based services. It does not cover charges for:
  • Care that is not needed (care not approved by a Fairview doctor or trial treatments)
  • Care not offered at Fairview
  • Services given at Fairview by independent providers
  • Services not billed by Fairview
  • Services related to transplant
     
Fairview's Charity Care Program does not include care received in free-standing ambulatory service centers. This is covered under Fairview's Charity Care Program. Fairview has a number of financial assistance programs.

If you do not know whether the care you are seeking is covered by Fairview Charity Care, please ask us. If you have questions, call 612-672-6724 or (toll-free) 866-417-3560.

Income guidelines
If you qualify for the program, 100 percent of your bill will be paid. You must comply with all the terms of the program when you apply, and we also ask you to follow the rules set by your insurance plan.

Income guidelines by family size
Family sizeAnnual gross income
  1$32,670
  2$44,110
  3$55,550
  4$66,990
  5$78,430
Asset guidelines

The applicant’s combined savings and checking accounts may not exceed $15,000 (household of one) or $25,000 (household of two or more) in order to be eligible for Charity Care. Combined Retirement funds may not exceed $50,000 (household of one) or $100,000 (household of two or more) in order to be eligible for Charity Care.

How to apply

Thank you for your interest in Fairview’s Hospital Charity Care program.

To apply, review the instructions below and complete our Charity Care application form. The application is also available Spanish , Somali , Vietnamese, and Russian.

Step 1: Complete and sign this form.

  • List the names and birth dates for each family member applying for the program. If you do not list them on the form, they will not be included.
  • If your spouse is also applying for this program, both of you must sign the form.
  • Your family includes a spouse, dependent children and any person for whom you have legal guardianship.
     
Step 2: Attach these items to the form. We will keep your records confidential (private). Please include records for all adults in your household.

  • A copy of your most recent 1040 Federal Income Tax form. Do not include W2 forms.
  • Records of income over the past three months. (Example: pay stubs that show your year-to-date earnings.)
  • Copies of bank statements for all checking and savings accounts for the last 90 days. Include the last statement for any CDs (Certificates of Deposit).
  • Records of all retirement savings: employee pension plans, 401K plans, 403b plans, annuities, IRAs.
  • Record of current balances in all health savings accounts (HSA).
  • Optional: a letter explaining any recent events that might affect your ability to pay your medical bills.
     
Step 3: Return the form with the above records to the following address:

Patient Financial Services
Attn: Charity Care
400 Stinson Blvd NE
Minneapolis, MN  55413

Step 4: If you have applied for insurance coverage via MNsure or the Affordable Care Act, send the application results.

Charity Care may help pay your Fairview bill. It is only used in times of need—it does not replace insurance. If you or your spouse can get insurance through an employer, but you’ve chosen not to, then you cannot take part in this program.

You will keep receiving bills until we have your complete application. This includes the records listed above. If there are legal fees related to your account, you are not eligible for charity care.

Financial Assistance Policy
The Financial Assistance Policy is available in the following languages: English, Spanish, Somali, Vietnamese and Russian.

Financial Assistance Plain Language Summary
The Financial Assistance Plain Language Summary is available in the following languages: English, Spanish, Somali, Vietnamese and Russian.

Provider Lists
Fairview has a list of all provider groups that provide emergency and medically necessary services to patients at a Fairview Hospital facility. The list identifies which providers are and are not covered by Fairview’s Financial Assistance Policy.

Fairview Health System Covered Provider List
Fairview Health System Non-Covered Provider List

Billing and Collections Policy
The billing and collections policy is available in the following languages: English, Spanish, Somali, Vietnamese and Russian.


Discrimination is Against the Law. We comply with applicable Federal civil rights laws. We do not discriminate against, exclude or treat people differently because of race, color, national origin, age, disability or sex.
 
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