If a patient does not qualify for any State or Federal programs, they may still be able to obtain assistance through this program based on the prior year’s total household income.
In order to process your Patient Financial Assistance Program application, you will need to provide us with a copy of all the following:
- 1040 tax papers
- Printout from Social Security office
- Proof of disability, pension, social security, unemployment, and/or child support payments
- The same information for anyone else in the home who is working
How do I get help?
Please first review this informational letter on patient financial assistance, and completely fill this application (PDF). Bring the printed application and other required documents to the Albemarle Hospital Patient Financial Services (Billing Department) Office, located on the campus of Albemarle Hospital in the Annex building, which is on N. Road Street/Highway 17 between Medical Drive and the hospital’s main entrance driveway. Applications are also available from any of our Registration areas or Patient Financial Services.
For additional information please call (252) 384-4648.
When should I apply for help?
In most cases, the patient needs to apply for assistance within 90 days of a visit.
When Will I Know If I Qualify?
It may take anywhere from two to three weeks to determine eligibility. We will receive notification by mail of your acceptance into the program.