Financial Assistance

What Duke Will Do for You

Our commitment is to provide you with care that demonstrates a high level of dignity, respect, and skill.

Can’t Pay a Bill? We Can Help

Please tell us if you cannot pay your bill in full--we can help you. Our account representatives and financial care counselors can assist you with filling out applications for government-sponsored programs and describe monthly payment plans, and other financial assistance programs, that may be available for those who meet certain financial criteria.

Financial Assistance Eligibility

Patients who receive treatment at a Duke University Health System (DUHS) facility and demonstrate an inability to pay may receive discounted services under DUHS' Financial Assistance Policy.

This policy applies to DUHS and all its entities, including the following:

  • Duke University Hospital
  • Duke Regional Hospital
  • Davis Ambulatory Surgery Center
  • Duke Raleigh Hospital
  • Duke Primary Care
  • Duke Homecare & Hospice

The Private Diagnostic Clinic, PLLC (PDC) has no prescribed financial assistance policies, but as an accommodation and courtesy to PDC patients, the PDC has elected to follow the financial assistance determinations made by DUHS under this policy.

Durham Emergency Physicians, PA and Durham Radiology Associates, Inc. have separate financial assistance policies but have elected to follow the financial assistance determinations made by DUHS under this policy.

Medical treatment that is urgent or provided on an emergency basis is eligible for a financial assistance discount under the DUHS Financial Assistance Policy.

Examples of this type of treatment include:

  • Treatment provided in a DUHS Emergency Department
  • Treatment provided in an inpatient setting following an urgent admission to a DUHS hospital
  • Follow-up treatment to services provided through the Emergency Department once a follow-up visit and evaluation has occurred with a Duke physician

Health care services necessary to prevent a serious health impact as determined by a Duke physician also may be eligible for a financial assistance discount.

Transplant, experimental, and elective services are not eligible for a financial assistance discount.

Patients may receive up to a 100 percent discount on eligible services. Discount amounts are based upon a patient's household income compared to percentages of the current Federal Poverty Income Guidelines.

2018 Duke Patient Revenue Management Organization (PRMO) Financial Assistance Sliding Scale

% of Poverty Guidelines






Discount Received

Poverty Level






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Patients who have large out-of-pocket costs after insurance may also be eligible for financial assistance discounts. These medical hardship situations impact a patient's ability to pay for basic living expenses and are evaluated on a case-by-case basis.

Other types of patients that may be approved for financial assistance adjustments:

  • Deceased patients with limited value estates
  • Patients with collections balances in verified Chapter 7 or Chapter 13 bankruptcy
  • Project Access patients
  • Patients approved for treatment at Southern High School
  • Inpatient and outpatient patients that express an inability to pay for outpatient prescription medications from Duke’s retail pharmacy

Applying for Financial Assistance

For care provided through the emergency department, and for many uninsured patients receiving eligible services, no formal application is required. Patients will be screened for potential financial assistance eligibility via a third party screening service. During the visit, financial counselors can meet with you to determine whether there are any outside forms of financial assistance, such as Medicaid or the Crime Victim or Cancer Control Programs, that can help pay for your services.

If outside financial assistance is not available, then we will automatically apply a financial assistance discount to your bill based on your reported income level.

For other eligible inpatient and outpatient services, DUHS financial counselors can assist you with applying for outside forms of financial assistance or financial assistance during your stay or visit.

To qualify for a financial assistance discount, you must provide us with the necessary information and documentation to determine whether any forms of outside financial assistance are available. You may be denied financial assistance if you or your family fails to cooperate with this process.

If you believe that you qualify for financial assistance or other forms of outside financial assistance, but have not spoken with a financial counselor or received a discount, then please contact customer service at 919-620-4555 or 800-782-6945. An internal version of the DUHS Financial Assistance Self Pay Collections policies can be obtained by sending a request in writing to the Self Pay Collections Department at 5213 South Alston Ave, Durham, NC  27713. You can also pick up copies of the policies or application at any DUHS patient registration location.

Download the documents:

Amounts Generally Billed

Patients who do not have insurance or other third party coverage will get a discount on their bill equal to the best discounts offered to insurance companies. This discount is automatically applied to your bill, and Duke Health uses the Look Back method to calculate this discount. For more information on how to obtain the current discount percentage and how it was calculated, please submit a request in writing to “Self Pay Collections, 5213 S Alston Ave, Durham, NC 27713”.

We Bill Your Insurance Directly

For services typically covered by insurance, we will bill your primary insurance company, and, if applicable, your secondary insurance company (including Medicare and Medicaid).

Please remember that health insurance coverage varies, so some services may not be covered. If you have questions regarding your health insurance coverage, please call your insurance company so you fully understand how your policy works prior to receiving care at Duke.

Statements for Unpaid Balances

Collection process

You will receive monthly bill(s) for amounts greater than $10 that DUHS determines are your responsibility after any insurance plan payments have been applied.

You will be contacted four times (via billing statements, phone calls, and e-mails) during a 120-day period reminding you of your bill(s). During this period, you will be expected to pay your bill(s) in full, establish a payment plan or apply for financial assistance.

If the balance due is unpaid or otherwise unresolved after the 120-day period, your account will be sent to a collection agency. Your credit may be impacted if the balance is not resolved 60 days after collection agency placement.

In select cases, DUHS may choose to engage an attorney in a collection action. This step would occur only after DUHS has thoroughly reviewed your account and determined that you are not eligible for financial assistance or other forms of assistance.

A billing and collections policy describing the possible actions in the event of nonpayment can be obtained by sending a request in writing to the Self-Pay Collections Department at 5213 South Alston Ave, Durham, NC 27713.

Payment plans

DUHS offers interest-free payment plans that are up to six years in length, depending upon your account's balance. Payment plans may be established prior to, at the time of, or after services have been delivered. For payment plans established prior to or at the time of service, the first month’s payment must be made to establish the plan, and the patient must not have any other outstanding bills with DUHS.

Please contact customer service at 919-620-4555 or 800-782-6945, contact a financial care counselor at one of our locations or visit to establish a payment plan.

Financial brochure

Please refer to our brochure (PDF, 456 KB), which provides more information on insurance and the patient billing process.

Methods of Payment

For your convenience, we accept cash, checks, and all major credit cards. Payment is due 15 days after you receive a bill.

Overpayment Questions

Please contact customer service at 919-620-4555 or 800-782-6945 if you have any questions regarding overpayments. If applicable, we will apply any overpayments to your other outstanding balances.

Itemized Statements for Attorneys

If your account is a result of an automobile accident or other accident caused by another party, you can request that itemized statements be sent to any attorney involved in the account.

However, you will remain responsible for making payment on the account until the dispute is settled. We will follow all regulations related to accident coverage for patients covered by Medicare or Medicaid.

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