Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines: 

Disclaimer

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

See the list of providers for Southern California.

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.

Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.

You will need to provide:

• The reason why you’re appealing (job loss, for example)
• Current financial documentation of your total gross household income to support your appeal (refer to the table shown in the “What information will I need to apply” section above for the required documentation of your income)

You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.

To do this, you should provide the following:

• Proof of income for your annual gross household income
• Proof of non-Kaiser Permanente medical and/or dental expenses
• You must provide an itemized bill with the following information:
  • Provider’s name and address
  • Patient’s name
  • Description of services or supplies provided

You will not be refunded for any payments you make before an appeal is approved.

You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.

To appeal for a larger award, you may appeal at any time before the award end date. 

If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.

To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:

• By fax: 1-866-519-1693
• By mail:
  Kaiser Permanente MFA Program​
  P.O. Box 7086​
  Pasadena, CA 91109-7086

Send copies of official documents; originals are not required.

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

Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.

A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a KP facility by private health insurers, Medicare fee-for-service and Medicaid fee-for-service (and copays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2022, to September 30, 2023, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2024 AGB reduction, also known as an adjustment, to gross charges is 65% for hospital charges.

Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-800-464-4000.

Accessible alternative formats include large print, Braille, and audio.

For help or questions about the medical financial assistance application process or other questions, please call 1-800-390-3507 or speak to a financial counselor in the Admitting Department at any Kaiser Permanente medical facility.

Help paying your bill

There are free consumer advocacy organizations that will help you understand the billing and payment process. You may call the Health Consumer Alliance at 1-888-804-3536 (TTY 711) or go to healthconsumer.org for more information.

Hospital Bill Complaint Program

The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program. Go to HospitalBillComplaintProgram.hcai.ca.gov for more information and to file a complaint.

Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:

Disclaimer

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.

Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.

You will need to provide:

• The reason why you’re appealing (job loss, for example)
• Current financial documentation of your total gross household income to support your appeal (refer to the table shown in the “What information will I need to apply” section above for the required documentation of your income)

You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.

To do this, you should provide the following:

• Proof of income for your annual gross household income
• Proof of non-Kaiser Permanente medical and/or dental expenses
• You must provide an itemized bill with the following information:
  • Provider’s name and address
  • Patient’s name
  • Description of services or supplies provided

You will not be refunded for any payments you make before an appeal is approved.

You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.

To appeal for a larger award you may appeal at any time before the award end date. 

If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.

To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:

• By fax: 1-877-899-5635
• By mail:
  Kaiser Permanente MFA Program
  Nine Piedmont Center
  3495​ Piedmont Rd., NE
  Atlanta, GA 30305-1736

Send copies of official documents; originals are not required.

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

Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.

Amounts Generally Billed apply to eligible hospital services rendered at a Kaiser Foundation Hospital only and do not apply to services provided by the Georgia Region.

Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 404-949-5112.

Accessible alternative formats include large print, Braille, and audio.

For help with the medical financial assistance application or other questions, please call 404-949-5112, or speak to a business office supervisor in the Patient Business Office at your local Kaiser Permanente medical office.

Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:

Disclaimer

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

See the list of providers for Hawaii.

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.

Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.

You will need to provide:

• The reason why you’re appealing (job loss, for example)
• Current financial documentation of your total gross household income to support your appeal (refer to the table shown in the “What information will I need to apply” section above for the required documentation of your income)

You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.

To do this, you should provide the following:

• Proof of income for your annual gross household income
• Proof of non-Kaiser Permanente medical and/or dental expenses
• You must provide an itemized bill with the following information:
  • Provider’s name and address
  • Patient’s name
  • Description of services or supplies provided

You will not be refunded for any payments you make before an appeal is approved.

You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.

To appeal for a larger award you may appeal at any time before the award end date. 

If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.

To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:

• By fax: 808-432-7950​
• By mail:
  Kaiser Permanente
  Attention: MFA Program — Business Services​
  3288 Moanalua Road​
  Honolulu, HI 96819​

Send copies of official documents; originals are not required.

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

Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.

A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service (and copays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2022, to September 30, 2023, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2024 AGB reduction, also known as an adjustment, to gross charges is 62% for hospital charges.

Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 808-432-5955.

Accessible alternative formats include large print, Braille, and audio.

For help with the medical financial assistance application or other questions, please call 808-432-7940 or 1-800-598-5928, or speak to a financial counselor in the Business Services Department at the Kaiser Permanente medical facility.

Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines.

Disclaimer

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

See the list of providers for the Northwest.

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.

Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.

You will need to provide:

• The reason why you’re appealing (job loss, for example)
• Current financial documentation of your total gross household income to support your appeal (refer to the table shown in the “What information will I need to apply” section above for the required documentation of your income)

You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.

To do this, you should provide the following:

• Proof of income for your annual gross household income
• Proof of non-Kaiser Permanente medical and/or dental expenses
• You must provide an itemized bill with the following information:
  • Provider’s name and address
  • Patient’s name
  • Description of services or supplies provided

You will not be refunded for any payments you make before an appeal is approved.

You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.

To appeal for a larger award you may appeal at any time before the award end date. 

If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.

To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:

• By fax:  1-877-829-3547​
• By mail:
  Kaiser Permanente​
  Attention: Financial Counselors​
  500 NE Multnomah St.​
  Portland, OR 97232

Send copies of official documents; originals are not required.

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

Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.

A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service and Medicaid fee-for-service (and copays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2022, to September 30, 2023, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2024 AGB reduction, also known as an adjustment, to gross charges is 64% for hospital charges.

Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-800-324-8010, or TTY 711.

Accessible alternative formats include large print, Braille, and audio.

For help with the medical financial assistance application or other questions, please call 1-800-813-2000.

Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:

Disclaimer

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

See the list of providers for Washington.

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.

Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.

You will need to provide:

• The reason why you’re appealing (job loss, for example)
• Current financial documentation of your total gross household income to support your appeal (refer to the table shown in the “What information will I need to apply” section above for the required documentation of your income)

You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.

To do this, you should provide the following:

• Proof of income for your annual gross household income
• Proof of non-Kaiser Permanente medical and/or dental expenses
• You must provide an itemized bill with the following information:
  • Provider’s name and address
  • Patient’s name
  • Description of services or supplies provided

You will not be refunded for any payments you make before an appeal is approved.

You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.

To appeal for a larger award you may appeal at any time before the award end date. 

If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.

To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:

• By fax: 206-877-0640
• By mail:
  Kaiser Permanente​ MFA Program
  P.O. Box 34584​​
  Seattle, WA 98124-1584

Send copies of official documents; originals are not required.

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

Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.

A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser Permanente facility by Medicare fee-for-service and Medicaid fee-for-service (and copays) for emergency or medically necessary services, based on actual claim data from October 1, 2022, to September 30, 2023, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2024 AGB reduction, also known as an adjustment, to gross charges is 46% for hospital charges.

Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-888-901-4636.

Accessible alternative formats include large print, Braille, and audio.

For help with the medical financial assistance application or other questions, please call 1-800-442-4014 or speak to staff at the Business Office or at the check-in desk at any Kaiser Permanente medical facility.