The document provides two sample request letters asking for financial assistance to pay hospital bills. Ask for a copy of the policy.Please call our Patient Financial Services at 909-272-9403, Monday through Friday, 8 a.m. to. These sample letter templates are provided as a reference for practices developing their own materials and may be adapted to local needs. Once we receive the requested documentation, we'll send you a letter regarding the decision on your appeal within 30 days. Despite qualifying for financial assistance, patients are still getting large medical bills from hospitals. Need help getting the application, filling it out or turning it in? Download Application. There also may be protections under federal and state law as well as financial assistance that you may be entitled to claim.