Patient financial assistance program for hospital services

UCLA Health strives to provide quality patient care and meet high standards for the communities we serve. UCLA Health is committed to helping eligible patients who are not able to pay for all or part of their care. UCLA Health’s commitment to our mission and vision includes providing full financial assistance (100% discount) or partial discounts to eligible patients who are low income, uninsured or under-insured. Further information on UCLA Health’s Financial Assistance Program is provided below.

Eligible services

The Financial Assistance Program applies to emergency or other medically necessary healthcare services provided and billed by UCLA Health. Separately-billed physician professional services furnished in inpatient, outpatient, and emergency hospital departments are not eligible for consideration under the Financial Assistance Program.

Determination of eligibility

Eligibility is determined based on review of a completed Financial Assistance Application and supporting documents, including proof of income, assets and liabilities. Generally, patients with family income at or below 400% of the Federal Poverty Level will be eligible for a discount of 100%. Patients with family income between 401% and 450% of the Federal Poverty Level may be eligible for a partial discount based on income level.

If you receive financial assistance under our policy, you will not be charged more for emergency or other medically necessary care than the amount generally billed to patients having Medicare fee-for-service coverage. In some instances, patients may be presumptively determined eligible for financial assistance.

To view U.S. federal poverty guidelines used to determine financial eligibility, visit:

How to obtain copies of our financial assistance policy and application

You may obtain a copy of our Financial Assistance Policy and application:

  • On this page of the UCLA Health website (see links below).
  • In our Emergency Departments, Patient Access Services Department (see address below), any UCLA Health location where patient registration occurs and in our Patient Business Services Office (see address below).
  • To request documents by mail, contact our Patient Business Services Office at 310-825-8021 (Monday through Friday, 8:30 am to 4:00 pm).

How to obtain information and assistance regarding our financial assistance program

For information regarding our Financial Assistance Program or assistance with the Financial Assistance Application, contact our Patient Business Services Office at 310-825-8021 (Monday through Friday, 8:30 am to 4:00 pm), or visit us at 10920 Wilshire Blvd, Suite 1600, Los Angeles, CA 90024


The Financial Assistance Policy, Financial Assistance Application, and Plain Language Summary are available in English, Spanish, Farsi, Arabic and Chinese in the “Documents” section below on this page, or separately in paper upon request.

If you would like an interpreter to help you with a different language, please contact our Interpreter Services Program at 310-267-8001. The UCLA Health Interpreter/Translation Services Program provides services to all UCLA Health inpatients, outpatients and their relatives at no cost. For more information regarding UCLA Health’s Interpreter/Translation Services Program, visit:

How to apply for our financial assistance program

The Financial Assistance Application is found below on this page, and may be hand-delivered or mailed, with all supporting documents, to:


Monday through Friday, 8:30 am to 4:00 pm

Patient Access Services Department
757 Westwood Plaza
Los Angeles, CA 90095

Patient Business Services Department
10920 Wilshire Blvd, Suite 1600
Los Angeles, CA 90024

Mail to:

Patient Business Services Department
10920 Wilshire Blvd, Suite 1600
Los Angeles, CA 90024

Financial assistance program documents

Financial Assistance Application

Plain Language Summary

Financial Assistance Policy