Program
Spartanburg Regional Healthcare System is committed to providing healthcare to those in need, regardless of their ability to pay. In support of this commitment, Spartanburg Regional has established a Financial Assistance Program for uninsured patients and/or those with limited financial resources.
To find out if you are eligible for Spartanburg Regional’s Financial Assistance Program, complete all fields on the financial assistance application, the asset questionnaire, the provider statement (if applicable), and submit the required documents. You may either complete the application in MyChart and upload documents such as proof of income, or download and print the application using the links below. Applications with missing information will be considered incomplete and will be denied.
- Financial Assistance Application - English
- Financial Assistance Application - Spanish
- Financial Assistance Application - Ukrainian
- Financial Assistance Application - Russian
In addition to the completed financial assistance application, the following documents are required for your application to be processed:
- Most recent year's tax return, including all applicable tax schedules
- if you are claimed on someone else’s taxes, provide a copy of their tax return
- if you are employed but did not file a tax return, provide your three most recent pay stubs
- Social Security Administration letter, if applicable
- Unemployment benefits statements, if applicable
- Asset questionnaire: Please provide the most recent month’s financial document to support any assets listed.
- Provider statement:
- If you have zero or limited income and someone else is helping you pay your monthly expenses, please have them complete a provider statement. This is a signed statement explaining monthly support from your provider with dollar amounts of the care that is provided to you. This includes room & board, personal expenses, etc.
- Provider statement - English
- Provider statement - Spanish
- Provider statement - Ukrainian
- Provider statement - Russian
Upon completion of the forms above, please review for accuracy and submit all application information and documentation via email to [email protected] or by mail to:
SRHS Patient Financial Assistance Program
Patient Financial Services
101 East Wood Street
Spartanburg, SC 29303
We will review your application to determine if you qualify for assistance. If there are special circumstances that affect your ability to pay, please include them with your application.
Your complete application will be reviewed by one of our Financial Counselors. You will receive a written decision promptly, usually within 30 days of submitting your application. If you are denied assistance, the reason for denial will be provided. If you are approved for partial assistance the decision will also provide you with information on how to set up a payment plan.
Policy
Spartanburg Regional Healthcare System is a charitable organization dedicated to providing care, regardless of ability to pay.
- Your financial circumstances will not affect the care you receive. All patients will be treated with respect and fairness.
- Assistance is available for medically necessary care. Patient may apply for financial assistance at any time during the continuum of care.
- If you have no health insurance and/or limited financial resources, you may be eligible for free or discounted services.
- The amount of financial assistance you receive is determined by SRHS’s Financial Assistance Guidelines.
- Depending on the amount of your bill and your financial circumstances, minimum monthly payments may be accepted with no interest charged.
- If you do not qualify for financial assistance but believe you have special circumstances, you can request that your case be reviewed by a SRHS Business Services Supervisor / Financial Counselor.
- If you apply for financial assistance, you must provide us with all information necessary to apply for other financial resources that may be available to you, such as Medicaid or Medicare.
- You are responsible for applying for financial assistance. SRHS will make application materials easily available. To request an application call 864-596-1001 or 800-281-5346. Additionally, you may download the form here.
- You may qualify for financial assistance if your household income is less than or equal to 2 times (200%) of the current Federal Poverty Guidelines.
- You may qualify for partial financial assistance depending upon your household income and the number of members in your family. This is also based on the U.S. Government’s Federal Poverty Guidelines.