To write a letter requesting help with hospital bills, start with a polite greeting and introduce yourself, mentioning your situation briefly. The document provides two sample request letters asking for financial assistance to pay hospital bills.Work with our team of financial counselors who help you understand medical bills, insurance coverage and financial assistance at Phoenix Children's. PATIENTS WITH NO INCOME SOURCE will need to provide a letter giving their name and explaining why they are requesting Financial Assistance. Dear Sir or Madam: I am writing to notify you of my inability to pay the abovereferenced bill for (describe your condition and treatment). Enclosed is a copy of my completed application for financial assistance. See if you qualify for medical bill forgiveness from Valleywise Health Medical Center (Maricopa Medical Center) or any other U.S. hospital. Thank you for offering a financial assistance program. A hardship letter is a formal letter that you write to your healthcare provider or insurance company to request assistance or a payment plan. Call (855) 432-7587 to request a paper application be mailed to you.