The Financial Assistance Program is designed for patients who need help paying for healthcare.
Assistance under the Arizona Healthcare Cost Containment System, or AHCCCS, is available for eligible and emergency care services at Flagstaff Medical Center, Verde Valley Medical Center, Verde Valley Medical Center – Sedona Campus, Verde Valley Medical Clinic – Village of Oak Creek, Verde Valley Medical Clinic – Camp Verde, and EntireCare Rehab & Sports Medicine. Assistance is based on income and family size.
Please note: Services provided by physicians not employed by NAH, or services for which a third party is liable, are not eligible for the Financial Assistance Program.
You will be notified, in writing, whether your application for assistance is approved or denied.
To be eligible for NAH’s Financial Assistance Program, you must be:
- Ineligible for Medicaid; approved for Medicaid after the date of medical service; or Medicaid-eligible but receiving services not covered by Medicaid.
- Receiving medically necessary care.
- Able to demonstrate financial need according to the federal poverty level, or FPL, which means your gross income is less than 400 percent of the minimum amount required to sustain a family as determined by the U.S. Department of Health and Human Services.
What you need to provide
You must provide the necessary documentation to be eligible for the Financial Assistance Program. This documentation includes:
- A complete copy of your signed prior year federal tax returns.
- A determination letter from AHCCCS or other state government-funded program, such as Medicaid or Medi-Cal, or proof of ineligibility based on FPL.
- Proof of total household income for all adults age 18 and older; and full-time students under age 24. Acceptable documentation may include:
- Three months of personal bank statements for all accounts, such as checking and savings.
- Proof of employed patient or guarantor income.
- Three consecutive check stubs or a letter from your workplace’s Human Resources Department (if employed).
- Copies of unemployment payments or a statement of means of support (if unemployed).
- A copy of your Social Security Administration 1099 form (if retired or on Social Security).
- Copies of any pension benefit letters.
- Income from other sources, including rent, alimony, child support or other.
Presumed financial assistance criteria
In general, we assume a patient is eligible for financial assistance for a care encounter if he or she is:
- Awarded AHCCCS coverage, but coverage is not retroactive to the date of service.
- Covered by AHCCCS the month before or after receiving care.
- Indigent, or homeless, based on residency validation.
- Incarcerated, and care is not the financial responsibility of the local, state or federal institution.
- Bearing an invalid Social Security number.
Please note: Presumed financial assistance is by encounter only and cannot be used for future balances.
To learn more about the policy, or to apply for financial assistance, download these PDF files.