patient assistance
Financial-assistance application and Billing Services help
Confirm the exact product or service
National contact — confirm product and location
Return completed financial-assistance application and required supporting documentation, per application page 1.
Current cost-saving page links application [47839], filename 0725. Page 1 directs applications to Accounts Receivable, Attention: Settlements. No email is printed in these instructions; web-page generic mail/fax/email language does not establish an email route. Visible footers are copyright 2024 on page 1 and 2025 on page 2, not issuance dates. PDF extraction contains hidden CPL template text, excluded after visual inspection. Eligibility and supporting documentation require AEL review.
View source ↗ · Source checked 2026-10-22 · Current page linking this application ↗
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