Financial Assistance

JPS Health Network offers financial assistance with our JPS Connection Program. Uninsured patients that do not qualify for JPS Connection will get a self-pay discount of at least of 40% off the bill.

How Do I Get Financial Assistance?

To get financial assistance, you will need to complete a JPS Connection application and submit it... You can request financial assistance during your hospital stay, office visit, or up to 90 days after you visit. Below are the basic requirements for financial help:

  1. Your income is at or below 250% of the current Federal Poverty Guideline
  2. You live in Tarrant County
  3. You are a US citizen or legal permanent resident
  4. You are not eligible for other assistance like Medicaid or VA coverage

Use this link to find out where your income level falls:
http://aspe.hhs.gov/poverty/index.cfm

How Can I apply for Financial Assistance?

You can obtain a free copy of the application and the Financial Assistance Policy from any of the sources below:

  1. Online: Download or submit an application from JPS Health Network website at https://jpshealthnet.org/financial-resources/jps-connection
  2. Mail: Request an application by calling 817-702-1001 between the hours of 8 a.m. and 5 p.m.
  3. In Person: Financial assistance forms and applications are available at 1325 S. Main St. Fort Worth, TX 76104 or any Eligibility location, registration/admission area, and also in the Emergency Department. We can translate forms into other languages.

Supporting Documents

If you apply for JPS financial assistance (JPS Connection) you will be responsible for providing the following information.

  1. The address of the place where you live Income
  2. Other things you own that have value
  3. Citizenship
  4. Other Documents showing your qualifications

Proof of income may include check stubs, bank statements, income tax returns, and other sources.

Emergency and Medically Necessary Care

Patients that qualify for financial assistance will not be charged more for emergency or other medically necessary care. To determine the amount we owe we use the look-back method and find out an average of amounts paid by insurance companies on behalf of patients in prior years.