Financial Counseling Process
Financial Assistance for Urgent/Emergent Services Provided
- Financial assistance packets are provided to all uninsured patients treated in our Emergency Room and/or admitted to our hospital
- The packet contains an application for financial assistance as well as all of the supporting forms needed to complete the application process
- If you did not receive the packet or are in need of another packet and would like one mailed to you or if you simply have questions, please contact the Financial Counseling Office at (409) 772-6464 for assistance.
- Financial assistance applications and all supporting forms are also available for printing from this website, simply click here: Forms pageor click on the “Forms” button found on the left side navigation tab.
- Please fill out the application completely. The last page in the packet is an Approved Document List. Read this carefully and submit the requested documents with your application to the address below. You may also fax the application and documents to (409) 747-9900.
- Once your information has been received, a financial counselor will review the application and documents to determine if you qualify for a discount.
- The financial counselor may call you with questions regarding your packet. If information is missing, you will be notified of the documents that are necessary to complete your application.
- Depending on the information you provide, you may be requested to apply for health care assistance through your local county health district office or county Indigent Health Care Office.
- If you did not have your taxes filed by a professional and they were self-prepared, we will request that you obtain a transcript from the IRS. An IRS form 4506-T is included in your financial assistance packet, please complete and send in with your application. This form is also available for printing from this website, simply click here - Forms pageor on the “Forms” button found on the left side navigation tab.
- We are here to help, so please do not hesitate to contact us at (409)772-6464 with any questions you might have.
Financial Assistance for Planned Services
- Current UTMB and Non-UTMB patients should contact Financial Counseling at (409) 772-6464 to learn about referral requirements and the application process related to planned services.
- Although Financial Counseling will work with you to collect as much information as possible via fax or mail, at some point in the process it may become necessary to have a face to face interview. If this is the case, Financial Counseling will contact you to schedule required interviews when appropriate.
- Patients with a proven gross household income (including calculated assets) below 100% of the Federal Poverty Guidelines will not be subject to required deposits. However, payments made prior to completion of the financial assistance process are considered non-refundable. Patients with a proven gross household income (including calculated assets) will have a required deposit for all services at UTMB. Please refer to the Forms page for a copy of the Deposit Guide and additional information.
- If you have already applied for financial assistance and you have experienced changes in your financial status that are different than stated on your Financial Application, please notify our office within 14 day of the changes so that your financial status can be re-evaluated.
- Please contact Financial Counseling at (409) 772-6464, up to 30 days prior to the expiration date if a continued discount is desired. It will be necessary to provide a new application and updated financial documents to extend your discount.
Failure to follow this process will result in future scheduled appointments being cancelled. Your appointment will be rescheduled when the application process is complete.
Please contact us at (409) 772-6464 if you have questions or need to discuss an alternative way to complete this process.
UTMB Financial Counseling* Note: Some patients are excluded from the ability to receive or be considered for UTMB discounted services:
301 University Boulevard
Galveston, TX 77555-0309
- Non-Texas Residents
- Any insured patient including Managed Care, Commercial, Medicaid or any other insurance program