Request for Insurance Enrollment Assistance

If you or someone you care for is seeking assistance with Health Insurance or Financial Assistance to help cover healthcare-related expenses, please complete the below, and a member of our Patient Financial Advocacy team will reach out to you. For your reference, the team is currently available: Monday - Friday 8 am - 4 pm If you have any questions or concerns regarding your request, please call 315.261.5476 during our normal business hours and one of our Advocates will be glad to assist you within 24 business hours. We look forward to partnering with you. SLH Patient Financial Advocacy Team

 

Please enter the full name of the patient who needs assistance with insurance enrollment.

 

Please enter the patient's date of birth.

 
mm/dd/yyyy
 

Ex: 315.555.5555 In order to properly assist you, please provide the best contact number for the person the team is reaching out to. If this is not the patient, please leave a note providing the name of the person we are reaching out to and their relationship with the patient.

 

Please leave any additional information you feel the team may need to assist you. Ex: -Name of person we are contacting, if not the patient. -Preferred contact date and time