Saint Alphonsus Health System

Financial Application

Who is eligible for Saint Alphonsus assistance?

All patients, regardless of race, creed, gender, age, or national origin, may apply for financial assistance from Saint Alphonsus either in advance of or after receiving covered services.

Eligibility is determined on an individual basis, taking into account factors such as family size, income, assets and insurance status. Prior to completing this form, please contact our financial assistance office at the number listed below Monday through Friday from 8 a.m. to 4:30 p.m for an assessment of your qualifications.

  • For care and services provided at Saint Alphonsus Medical Center - Baker City, call 541-523-8816
  • For care and services provided at Saint Alphonsus Regional Medical Center in Boise, call 208-367-2130
  • For care and services provided at Saint Alphonsus Medical Center - Nampa, call 208-463-5538
  • For care and services provided at Saint Alphonsus Medical Center - Ontario, call 541-523-8816

Once you have completed the form Saint Alphonsus Financial Assistance Form, send it along with the supporting documentation to:
Saint Alphonsus Patient Accounts
PO Box 190930
Boise, ID 83719

Download the Spanish version of the Saint Alphonsus Financial Assistance Form here.