Patient Financial Assistance Program
InfuSystem offers financial assistance to individuals who meet our eligibility requirements. Patients may be required to apply for financial assistance by completing our Financial Assistance Application. We will also honor any uninsured or financial assistance discount that your healthcare provider offers. We require a copy of the award or approval letter to apply the discount.
Patient Financial Assistance Application
Please ensure to complete all required information to the best of your ability. This information is confidential and is only used for the purpose of determining your discount.
If you do not meet the income guidelines for the assistance program but are having difficulty paying your entire balance you may be eligible for a payment plan.
Mail Completed Application to:
3851 W. Hamlin Rd.
Rochester Hills, MI 48309
PATIENT FINANCIAL ASSISTANCE APPLICATION