The document provides two sample request letters asking for financial assistance to pay hospital bills. To write a letter requesting help with hospital bills, start with a polite greeting and introduce yourself, mentioning your situation briefly.These guides help you fill out your Medicaid Renewal and give examples of documents you can use to give proof of information we need to decide on help for you. Completing this form will start your request for hospital financial assistance. Enclosed is a copy of my completed application for financial assistance. Enclosed is a copy of my completed application for financial assistance. A Medical Assistance Letter is a formal request for financial aid or support to cover medical expenses. It may also provide up to 90 days of retroactive coverage for unpaid medical bills. You must request this coverage when you apply for Medicaid. Montefiore Einstein has consistently remained at the forefront of establishing leading-edge Financial Assistance programs for our patients.