Financial Assistance Requirements

Abbeville Area Medical Center will provide services at a reduced rate to uninsured patients who meet the financial requirements. Eligibility is based on financial need.  Click here to see a copy of our Charity Care Policy.  The primary factor in determining eligibility is an applicant’s income as compared to the federal poverty income guidelines.  Click here to see the federal poverty income guidelines.  These guidelines vary according to family size.  It is important that you provide us with as much detail as possible about each member of your household, including their income, and any additional information that affects your ability to pay.  Click here for a copy of our Financial Assistance Application.

Listed below are the requirements for the financial assistance application: 

1. Proof of Income For You And Everyone In Your Household
This may be provided by pay stubs, a federal income tax return, or declaration letters of disability or social security income. Listed below are examples of types of income. *If you do not receive any income, you will be asked to sign a non-income declaration form describing your current living conditions.  Click here for a copy of the non-income declaration form
o Wages from employment, including commissions, tips, bonuses, fees, etc.
o Income from operation of a business
o Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits
o Disability payments
o Unemployment payments 
o Rental income from real or personal property 
o Interest or dividends from assets
o Public assistance payments 
o Periodic allowances such as alimony, child support, or gifts received from persons not living in the household
o Sales from self-employed resources (any services such as contracting, lawn maintenance, or sales such as Avon, Mary Kay, etc.)
o Any other source not named above

2. Household Expenses
List all monthly expenses for the household and provide copies of invoices if possible.

3. Medicaid Denial Letter 
This is needed for the patient and may be obtained from any DSS office.  This is needed to show that you were not eligible for Medicaid at the time services were rendered. 

Abbeville Area Medical Center reserves the right to verify any of the information you provide including a check of your credit history. Failure to provide all the required information will cause your application to be delayed and/or denied. If you have any questions regarding how to complete the application, please contact our Patient Advisor to determine eligibility at 864-366-7842.