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Financial Assistance Application

Provider Information

Initial Eligibility Survey

Mountain View Charity prefers to fund insurance premiums and/or deductibles as a way to guarantee continued access to care.

Uninsured patients are required to seek health insurance coverage. If coverage is obtained, applicant needs to provide proof of insurance. If patient is denied insurance, applicant needs to provide a letter of insurance coverage denial. Funding will not occur until this step is met.

Please assist your patients in accessing Your Health Idaho to determine if they are eligible for insurance.

Patient Information