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Atrium hardship application 2025

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The document outlines the application process for the Hardship Settlement Discount at Atrium Health, aimed at insured or uninsured patients in North Carolina or South Carolina who exceed income limits for financial assistance. It details eligibility requirements, including a minimum balance due of $2,500 and cooperation with the review process. The document also explains the timeline for eligibility determination and provides sections for patient and applicant information, health insurance details, household income, financial assets, and necessary acknowledgments.

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Click ‘Get Form’ to open the atrium hardship application in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, Social Security number, date of birth, and account number accurately.
Next, complete the 'Applicant Information' section. Provide details about the applicant including their relationship to the patient, address, phone numbers, and employment information.
In the 'Health Insurance Information' section, indicate if the patient has health coverage. Fill in policy details if applicable and answer questions regarding job loss and COBRA coverage.
Proceed to 'Monthly Household Income'. List all sources of income for both the applicant and their spouse, ensuring accuracy in monthly gross amounts.
Complete the 'Financial Assets' section by detailing any bank accounts, investments, or properties owned. Be thorough to avoid delays in processing.
Finally, review your entries for accuracy before signing in the 'Acknowledgement and Signatures' section. Ensure all required fields are filled out completely.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who can apply for hardship?

You must have been sanctioned at 100% (or 50% or more for a couple) of your standard allowance for any amount of time. You (and your partner if you have one) must also have completed: your work-related requirements in the 7 days before applying.

What is considered an emergency hardship?

An unforeseeable emergency is a severe financial hardship resulting from an illness or accident, loss of property due to casualty, or other similar extraordinary and unforeseeable circumstances arising as a result of events beyond the control of the participant or (if permitted under the plan) beneficiary.

How does hardship assistance work?

While in a hardship program, your lender might reduce your monthly payments, lower your interest rate or even waive certain fees for a set period usually a few months to a year. The idea is to help you get back on track without damaging your credit or sending you deeper into debt.

How long does a hardship application take?

Once you submit your hardship withdrawal application, it will be reviewed. Generally this takes less than a day. However, if there are any questions about your application, additional review time may be needed. Typically, this further review takes 5-7 business days.