Financial assistance policy summary

Patient under the age of 26 who is present in the United States without a permanent residence in another country or the guarantor (i.e., person responsible for payment for services) for such patient and who meet the Family Income requirements set forth in the Financial Assistance Policy .

You may apply for financial assistance by completing a Financial Assistance Application. You may have to submit other paperwork with the application to see if you qualify. We have Financial Counselors available to help you with the application process in the Admitting Departments at both our Dallas and Plano locations (see below for address, business hours and phone numbers). You may be eligible to receive financial assistance in some cases without applying.

The Financial Assistance Application, this summary and the Financial Assistance Policy can be obtained in English, Spanish or certain other languages as follows:

Children’s Medical Center Dallas
Attn: Admitting Office
1935 Medical District Dr
Dallas, TX 75235

Children’s Medical Center Plano
Attn: Admitting Office
7601 Preston Rd
Plano, TX 75024

• In person at the Hospital Admitting department.

• By phone:

  • Dallas: 214-456-8640

  • Plano: 469-303-8640

  • Print Application (English)
    Print Application (Spanish)

  • By mail:

  • View applications in other languages:
    عربى  (Arabic) (pdf) | 政策 (Chinese) (pdf) | سیاست (Farsi) (pdf) | Française (French) (pdf) | नीति (Hindi) (pdf) | 방침 (Korean) (pdf) | English (pdf) | Español (Spanish) (pdf) | Patakaran (Tagalog) (pdf) | پالیسی (Urdu) (pdf) | Tiếng Việt (Vietnamese) (pdf)

Discount rates differ according to your patient Family Income. Please see below:

• Patients with a family income between 301 and 400% of FPG will receive a 70% discount.

• Patients with a family income between 201 and 300% of FPG will receive an 85% discount.

• Patients with a family income up to 200% of FPG will receive a 100% discount.

• An Eligible Applicant with a Self-pay Balance over the past 12 months exceeding 10% of the Eligible Applicant’s Family Income, who has exhausted all third-party payment sources, whose Family Income exceeds 400% of the FPG, and who is unable to pay the Self-pay Balance is eligible for a write-off of 85% of the Self-pay Balance if the Family Income is greater than 400% but less than 500% of FPG and 70% of the Self-pay Balance if the Family Income is in excess of 500%.

A person who is eligible for financial support will not be charged more than the amounts generally billed (AGB) to individuals with insurance for emergency or other medically necessary care.

Attachment A:

Calculation of Amounts Generally Billed Effective Date: 07/21/2023 Page 14 of 14 Following a determination of financial assistance eligibility, an individual will not be charged more than the amounts generally billed (AGB) to individuals with insurance for emergency or other medical necessary care. The Children’s Health Provider use the “look-back method” to calculate the AGB using the previous year’s closed encounters. This method bases AGB on fully paid hospital claims where the primary payer is Medicaid fee-for-service, Medicare fee-forservice, Medicaid, and commercial health insurers. The Children’s Health Provider divides the sum of total payments made by those payers by the sum of total hospital charges for those claims to calculate the AGB. Closed claims during the prior fiscal year (12 months) are included in the calculation. The AGB is calculated annually and applied on a calendar basis.

Children’s Health Provider Fiscal Year 2024
Gross Charges: $5,170,627,502
Discounts/ Contractual: $2,868,145,193
Payments: $2,302,482,309
Discount Rate: 55%

AGB Rate for Calendar Year 2025: 45%

Financial Counselors are available to assist you with the application process in the Admitting departments at both our Dallas and Plano locations.

Children's Medical Center Dallas
1935 Medical District Dr
Dallas, TX 75235
Monday - Friday: 7:00 a.m. - 5:00 p.m.
Phone: 214-456-8640
Fax: 214-456-6351

Children's Medical Center Plano
7601 Preston Rd
Plano, TX 75024
Monday - Friday: 7:00 a.m. - 5:00 p.m.
Phone: 469-303-8640