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Application Process

Application Process:

  • Patients who live within the United States who feel they may be eligible may apply for the Charity Care Program.
  • The application must be filled out in its entirety and returned within 30 days.
  • Each patient will have an initial determination done prior to sending the application and will be reviewed for other programs prior to the sending of the Charity Care application.


  • Income: Total cash receipts before taxes derived from wages, salaries, welfare/social security payments, strike payments, unemployment, disability benefits, child support/alimony and net earnings from business and investment activities paid to the individual.
  • Household: A group of two or more persons related by birth, marriage or adoption who live together. All such related persons are considered members of one family.

Final determination:
Confluence Health will notify the applicant of its final determination within fourteen (14) days of receipt of the application and all documentation material. A patient may appeal a denial of eligibility for Charity Care by providing additional verification of income or family size to the patient services manager within thirty (30) days of receipt of notification.

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