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Community Care
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Forms

 

Financial Statement (pdf)

Financial Statement (Spanish) (pdf)

 

Please complete the form and return with your latest tax return and/or two recent pay stubs to: UW Hospital and Clinics Patient Accounts, 635 Science Dr. #200, Madison, WI 53711


Billing Information

Billing Frequently Asked Questions

Community Care

Medicare D Prescription Drug Plan

Paying Your Bill

UW Health's Community Care program is designed to help patients who are unable to pay for the medical care they receive. Community Care staff use the following guidelines to determine patient qualification: 
  • The patient has no assets that could be appropriately used to pay medical debt
  • The patient is ineligible for aid under county, state and federal programs
  • The patient lives in Dane County or the surrounding counties
  • The care is medically necessary
  • UW Health is the appropriate provider for the level of care required by the patient
  • The patient's family income level is at or below 500 percent of the federal poverty guidelines
  • The patient's medical debt is more than 50 percent of the annual household income, irrespective of income level
For more information about the Community Care program, contact UW Hospital and Clinics at (608) 262-2221 or toll-free at (866) 841-8535 or UW Medical Foundation at (608) 829-5254 or toll-free at (877) 565-8855.