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Click ‘Get Form’ to open the vidant financial assistance application in the editor.
Begin by checking the box next to each Vidant Health facility where you received services. This ensures your accounts are considered for financial assistance.
Fill in your Patient Account Number(s) in the designated field. This is crucial for identifying your records.
Provide information about the patient, including their full name and the name of the person responsible for medical bills or insurance.
Indicate whether you have health insurance by selecting 'Yes' or 'No'. If yes, list all health insurance providers.
Complete the household information section, detailing how many people live with you and if you've applied for Medicaid.
Document your annual income by filling out the income sources and providing supporting documentation as specified.
List any real estate and personal property, including tax values, ensuring all required details are included.
Finally, review all information for accuracy, sign the application, and date it before submission.

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What does financial assistance cover?

FAPs must apply to all emergency and medically necessary care furnished by the hospital and substantially related entities. If emergency and medically necessary care is provided by the hospital facility, the care must be covered under the FAP. Check for a Provider List.

What are the three types of financial assistance?

There are 3 different types of funding opportunities a student may look for, namely: Scholarship. Bursary. Study Loans.

Can you get a grant for medical expenses?

You may qualify if you are a senior citizen, fit income eligibility requirements, or have very high medical expenses. Check into grants and financial assistance programs through hospitals or organizations such as the Patient Access Network Foundation, HealthWell Foundation, or Samaritan Health Services.

Who qualifies for charity care in NC?

The Financial Assistance Program is available to North Carolina residents with a household income and assets at or below 300% of the Federal Poverty Guideline (FPG) for your family size. Meet FPG household income % for family size.