Applying for Financial Assistance

How to Apply for Financial Assistance

Medical expenses can be a financial burden. We are here to assist you or your family with medical expenses that you may accumulate for services at Nebraska Medicine facilities and from Nebraska Medicine providers. Any patient that may be eligible for financial assistance is welcome to apply. If you would like information about financial assistance, the application form is available for downloading below. Additionally, you can request a copy free of charge by e-mailing pasfinancialcounselors@nebraskamed.com or in person at one of the following locations.

Patient Access Services-Financial Counseling

Nebraska Medical Center
Clarkson Tower, Durham Outpatient Center and Lauritzen Outpatient Center
Omaha, NE 68198-7530
402.559.5346

Patient Access Services-Financial Counseling
Bellevue Medical Center
2500 Bellevue Medical Center Drive Bellevue, NE 68123 402.763.3061

Patient Financial Services
3333 Farnam St., Mutual of Omaha Building, 3rd Floor
Omaha, NE 68131
402.559.3140

All locations above are open from 8 a.m. - 4:30 p.m.

Once you complete the form, mail it to:

Nebraska Medicine
987530 Nebraska Medical Center
Omaha, NE 68198-7530

Apply for Medicaid

Financial Assistance Application Form

Plain-language Summary

Financial Assistance Policy

Amounts Generally Billed

Charity Scale

Providers Covered under Financial Assistance

  • Providers (See PDF attached to original page)