Help Paying Your Bill
It is Saint Agnes Medical Center's policy to address the need for financial assistance, discount payment eligibility and payment plan options in support of patients for emergency and medically-necessary services provided under applicate state or federal law.
Eligibility for financial assistance, discount payment eligibility, and support from Saint Agnes is determined on an individual basis using detailed criteria along with evaluation and assessment of the patient's and/or family's health care needs, financial resources and obligations.
Who is eligible for Financial Assistance, Discount Payment Eligibility and Payment Plans
Trinity Health will provide Financial Assistance and discount payment eligibility for services in a hospital facility (including services provided in the hospital facility by a substantially-related entity) and Saint Agnes will provide Financial Assistance and discount payment eligibility for the following services:
- All medically-necessary care and emergency medical care for:
- Self-pay patients who apply for and are determined to be eligible for Financial Assistance and discounty payment eligibility, and
- Patients presumptively eligible for financial assistance and discount payment eligibility
- Certain payments due from patients with coverage from a payer/insurer with whom Saint Agnes participates and contracts
The table below reflects 2024 Federal Poverty Level (FPL) and Charity Adjustment Guidelines for West Region Residents, as specified by Trinity Health. For financial questions and assistance after your hospital visit, please contact Customer Service at 1-866-626-7272.
2024 Federal Poverty Level (FPL) & Charity Adjustment Guidelines for Trinity Health West Region Residents
How to apply for financial assistance and discount payment
We're proud to offer three convenient ways for patients to apply for help paying their medical bills. Select from the accordions below to learn more.
Using your MyChart account, you can easily apply for financial assistance and discount payment directly through the platform!
- Login to your MyChart account
- Click 'Menu' in the top left corner of your screen (may appear as three horizontal lines only on mobile)
- Scroll down to 'Billing' and select 'Financial Assistance'
- Follow the directions on your screen and upload the specified documents to complete your application.
Don't have a MyChart account?
Learn more about the online platform and how you can sign up for a free account, here!
If it's more convenient for you or your loved one, you can print out and submit a paper application for financial assistance and discount payment.
- Print and complete the Financial Assistance and Discounted Payment Application.
- To better serve you, the Financial Assistance and Discounted Payment Application and additional resources have been made available in multiple languages on this page.
- Scroll down to the "Financial assistance and discounted payment documents" on this page to select, download and print the documents in your preferred language.
- Collect the documents needed to complete the application.
- Send all completed forms to:
Trinity Health Enterprise Patient Financial Services
On behalf of Saint Agnes Medical Center
20555 Victor Parkway
Livonia, MI 48152
If you have any questions or need assistance with the process, please call Customer Service at 1-866-626-7272.
You can contact Customer Service at 1-866-626-7272 to speak with a representative to help you navigate through the Financial Assistance and Discounted Payment process.
Financial assistance and discounted payments documents
If you would like to apply for financial assistance and discounted payments by "MAIL," please print and complete the application by selecting the box with your preferred language, below. If you have any questions or need assistance accessing any of the documents below, please call Customer Service at 1-866-626-7272.
No Surprises Billing Act - Balance Billing Protections
The No Surprises Act protects patients from large and unexpected surprise bills for out-of-network emergencies and certain non-emergency services provided at in-network health care facilities.
Learn more about the No Surprises Billing Act
Hospital Bill Complaint Program
If you believe you were wrongly denied financial assistance or discounted payments, you may file a complaint with the Hospital Bill Complaint program, a state program that reviews hospital decisions about whether you qualify for help paying your bill.
Get more information or file a complaint