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.You can request a financial assistance application at any time. Request an application for financial assistance. (commonly referred to as "Charity Care") from the Hospital billing department immediately. 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. If your bill is already past due or sent to a collection agency, reach out to the hospital's billing service provider and request a Charity. Intermountain Healthcare offers financial assistance to individuals who have received medical care in Intermountain clinics or hospitals. Clearly state the reason for your request, including details about your hospital bills and any financial challenges you're facing.