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.Enclosed is a copy of my completed application for financial assistance. Write the following information on the first page of your proof of income: First and last name; Medical record number (if any); Home address; Date of birth. Request an application for financial assistance. (commonly referred to as "Charity Care") from the Hospital billing department immediately.