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Financial Assistance 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, print the financial statement application and complete all fields on the form. Applications with missing information will be considered incomplete and will be denied.

In addition to the completed financial application, the following documents are required for your application to be processed:

  • Most recent year's tax return, including all schedules, signed by all tax payers on form
    • if you are claimed on someone else’s taxes, provide a copy of their tax form
    • if you are employed but did not file a tax return, provide your three most recent pay stubs
    • if you filed your taxes electronically, please sign the bottom of the form
  • Social Security Administration letter, if applicable
  • Unemployment benefits statements, if applicable
  • Provider statement
    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.

Upon completion of the form, please review for accuracy and mail with all application information outlined below to:

SRHS Patient Financial Aid 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, these 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.

More information about the Financial Assistance Program

If you have questions or need help completing the form, call Spartanburg Regional Healthcare System Business Services at 864-560-4123.

Review the Financial Assistance Policy

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