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.
Home Patient & Visitors Financial Assistance Charity Care Application Process

Definitions

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.

Useful Links

Charity Care Application

  • CCP Application: English
  • CCP Application: Spanish
  • CCP Application: Russian
  • CCP Application: Ukraine

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