The Financial Assistance Program is designed for patients who need help paying for care they’ve received. See below for information on eligibility, the financial assistance policy and application packet, and more. For assistance, please call 928-773-2025.
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, Northern Arizona Healthcare – Sedona, Northern Arizona Healthcare – Village of Oak Creek, Northern Arizona Healthcare – 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.
Eligibility criteria
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.
- Two months of personal bank statements for all checking and savings accounts.
- Proof of total household income, which may include:
- Two consecutive paycheck stubs or a letter from your employer stating your income (if applicable).
- A copy of your SSA 1099 benefits letter and/or pension statement (if applicable).
- Unemployment payment statements (if applicable).
- Other income including rent, alimony, child support or other sources (if applicable).
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.
- Incarcerated, and care is not the financial responsibility of the local, state or federal institution.
- Bankrupt.
Please note: Presumed financial assistance is by encounter only and cannot be used for future balances.
Learn more
To learn more about the policy, or to apply for financial assistance, download these PDF files.