Subject: Request for Financial Assistance Due to Medical Hardship

[Date: 6/29/2024]

[Recipient Name]
[Title]
[Medical Institution Name]
[Institution Address]
[City, State, Zip Code]

Dear [Recipient Name],

I am writing to you to formally request financial assistance due to a significant medical hardship that has impacted my ability to cover my healthcare costs. I have always prioritized my health and have responsibly managed my finances; however, the sudden and unforeseen medical challenges I am facing have placed me in a difficult and strenuous financial situation.

Over the past [duration], I have been undergoing treatment for [type of medical condition], which has resulted in substantial medical bills that I am currently unable to fulfill. My condition requires [specific treatment or medication], leading to expenses far beyond my financial capabilities.

I am employed at [Your Company's Name], but despite having health insurance, the costs of copays, deductibles, and treatments not covered by insurance are overwhelming. Due to my condition, I have also been unable to work to my full capacity, leading to a reduced income. The added financial stress has made it increasingly difficult to keep up with my day-to-day living expenses and support my family, let alone these additional medical costs.

I recognize the exceptional care and services provided by [Medical Institution Name], and it is with a heavy heart that I find myself in a position of needing to appeal for your compassion and support. Here is an outline of my current financial situation:

- My monthly income: $[Your Income]
- My monthly expenses (rent, food, utilities, etc.): $[Your Expenses]
- Total outstanding medical debt: $[Your Medical Debt]

I kindly request that you consider my application for financial assistance or a payment plan that is manageable given my current financial state. Any reduction in the medical bills, waiver of certain charges, or a tailored payment plan would provide immense relief.

Attached to this letter, you will find supporting documents including my recent pay stubs, a letter from my employer verifying my work situation, and a detailed list of my medical expenses.

I am hopeful for a positive response and deeply appreciate any help that [Medical Institution Name] can extend to me during this challenging time. Please feel free to contact me at [Your Contact Information] should you require additional information or documentation.

Thank you for taking the time to consider my request. I look forward to hearing from you soon.

Sincerely,

[Your Full Name]
[Your Address]
[City, State, Zip Code]
[Your Contact Information]
[Your Email Address]

Enclosures: [List of documents enclosed]