Uncompensated Financial Aid Program

Allied Services Rehab Hospital, Heinz Rehab Hospital, and Allied Home Health provide free, medically necessary care to persons who qualify. If you cannot afford the cost of care, you are encouraged to apply for free care. You may obtain information and an application at any outpatient clinic or by calling 570-348-1364 or 877-727-3422 or you may download an application below.

IMPORTANT NOTE: Financial aid services are only available at Allied Rehab and Heinz Rehab Inpatient and Outpatient facilities, and at Allied Home Health.

Provided below is an application for assistance with medical care through Allied Services Uncompensated Financial Aid Program. This program applies to all medically necessary charges incurred at Allied Services Rehab Hospital, Heinz Rehab Hospital or Allied Services Home Health.

Please note that this is only for facility charges and only those professional fees that appear on Allied Services bill. Arrangements for other fees cannot be made by this Health System and must be discussed with the individual practice plan.
Additional instructions are included in the application provided below.

Uncompensated Health Care Financial Assistance Program Policy
Uncompensated Health Care Financial Assistance Application

Financial Aid Policy
Plain Language Summary of Charity Care and Financial Assistance Policy

Uncompensated Health Care Financial Assistance Program Policy (Spanish)
Uncompensated Health Care Financial Assistance Application (Spanish)

Submission Instructions

You must include the following with your completed application:
Additional submission instructions are provided in the application.

• Your most recent federal income tax return, if you filed one, as well as the federal income tax return of anyone you claim as a dependent, or anyone that claimed you as a dependent.
• Other documents may include: W-2’s Social Security 1099’s, Social Security Award Letters, and/or pay stubs for 3 months. What you send will vary depending on the types of income your family had.
• If you feel you may not qualify, but the documentation does not fully explain your special circumstances, you may include a letter with an explanation. Additional credit may be granted according to your circumstances.

Once all your documents are in order, mail your completed application and all associated documents to:

Allied Services
Patient Accounts Department
UFA Program
100 Executive Park
Clarks Summit, PA 18411

For additional assistance with your application process, please contact:

Valerie Antonio
P: 570-348-1372
F: 570-341-4498
E: vanton@allied-services.org

For information on applying for medical assistance, see the following resources:

• Apply for medical assistance online
• County Assistance office contact information
• Medical Assistance offline application form