Mercy Health Physician Partners Grand Rapids


Financial Assistance Program

Mercy Health Physician Partners  does not refuse medically necessary or emergency care. We provide assistance to low-income individuals and those with special health care expenses who live in our service area.

Which Services Qualify

Services Covered

  • Medical Appointments – Includes health maintenance exams, well-child checks, diabetes visits, immunizations, obstetrics and gynecological care, school physicals, well visits and preventative health care among others.

Services Not Covered

  • Prescriptions – generic medications can be purchased through the $4 program at Walmart, Sams Club, Target or Family Fare, if available
  • Birth Control – of any type, including Depo Provera
  • Ambulance Services

Which Services Do Not Apply

Our Financial Assistance Program does not include the following:

  • cosmetic surgery
  • services that are not medically necessary
  • services to patients who qualify for county, state or federal assistance; other assistance programs; or other health care coverage
  • services that result from a patient going out of their insurance network for care
  • balances due to Insurance deductibles, co-pays or co-insurance

Patients may receive bills for services from other providers who assisted in their care at Mercy Health. These services may have been received in the Emergency Department, Radiology, from Anesthesia Physicians or from other professional providers. These services are not covered by the Mercy Health Financial Assistance Program. Please contact the other providers directly for questions, information and requests.

If you have questions about your bill or want to apply for financial assistance, please contact us at 616-685-8575.

Download the following application information to apply for financial assistance. Please note that both the financial assistance application and letter of support form requires official signatures. You can print and fill out the form by hand, or type in the required information, print and sign.

Financial Assistance Application Instructions

Financial Assistance Application Form

Verification Checklist

Health Insurance Marketplace Attestation

Letter of Support


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