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Apply for Financial Assistance

North Kansas City Hospital assists eligible persons who are uninsured, underinsured or indigent by waiving part or all of the charges for services provided by North Kansas City Hospital based on established criteria.

You may apply for financial assistance by downloading the form below or you may contact a Resource Counselor by calling 816-691-2598.

Complete the financial assistance application completely and return it with the requested documentation. If a question does not apply, write in "N/A."

Download a printable version of the Financial Aid Application

Download Spanish version

Return the application with the requested documentation listed below (make copies/do not send originals):

  • Copy of most recent year's Federal Income Tax Return Form 1040. (DO NOT SEND W2 FORM)
  • Copies of the most recent paycheck stubs for the last 30 days.
  • Proof of all other income.
  • Copies of the last two months' complete bank statements.
  • Please return the application and all documentation requested within 15 days to allow review and consideration of your application for possible financial assistance.

If you have any questions you may contact our office at 816-691-2598.

Mail the completed application to:

North Kansas City Hospital
Attention: Resource Counselors
2800 Clay Edwards Drive
North Kansas City, MO 64116