Please read the following notice. If you are interested in applying for family assistance, please print and complete the form and return it to our office for processing.
It is the policy of Family Care Associates of Effingham, S.C. to provide essential medical services regardless of the patient’s ability to pay. Assistance is offered based upon household income and size. A fee schedule is used to calculate the level of assistance and is updated each year using the federal poverty guidelines.
We respect the medical needs of all people who come through our doors, and the financial concerns of those with limited resources. We understand that patients with limited resources have the obligation and willingness to pay, but not always the ability to pay.
Eligibility requirements have been set for those who request Family Assistance. The guidelines are not meant to discourage anyone from seeking treatment. But, they are designed to ensure our resources are used for the people who need them most, and who are least able to pay.
We want to assist you in finding the best possible solution for you and your family. Before applying to the Family Assistance Program, a Patient Account Representative will first help you explore all possible options for financial assistance. Patient’s must then request and complete a Request for Family Assistance form. Along with your form, you must also provide financial information (W2s).
Income guidelines for eligibility are adjusted annually based on the FederalPoverty Guidelines established by the United States Department ofHealth and Human Services and published periodically in the Federal Register. These guidelines are subject to change without notice.
If you have any questions, please do not hesitate to call. Thank you.