Traducción para entender la carta. Se envía la carta en inglés.
Solicito ayuda financiera. Mi hogar tiene 3 personas y nuestros ingresos anuales son de $58,000.00, que es el 212.3% de las pautas de pobreza federal de 2026.
Su Política de Ayuda Financiera, revisada en mayo de 2026, otorga un descuento del 90% en este nivel de ingresos.
El formulario de evaluación financiera completado y los documentos que enumera están adjuntos.
English letter, the one that is sent:
SAMPLE — FICTIONAL DATA. NOT A REAL LETTER.
Dear Patient Financial Services team,
I am applying for financial assistance. My household has 3 people and our yearly income is $58,000.00, which is 212.3% of the 2026 federal poverty guidelines.
Your Financial Assistance Policy, Revised May 2026 lists a 90% discount at this income level. Policy p.11
The completed Financial Evaluation Form and the documents it lists are attached.
Attached: Financial Evaluation Form (filled, sign before sending); Documents listed in Table C of the form.
Memorial Regional Hospital BALANCES DUE FROM PATIENT INCOME AMOUNT OF DISCOUNT Up to 200% of FPG 100% Discount 201% - 250% of FPG 90% Discount 251% - 300% of FPG 85% Discount 301% - 350% of FPG 83% Discount 351% - 400% of FPG 83% Discount
You review and sign every letter.