Apply for Assistance

• Complete the Financial Assistance Application or call Financial Counselor Line at 706-721-1301. Please be prepared to provide all information necessary to apply for other programs available to you.
• Verify gross income and assets for family unit using the Financial Assistance Eligibility Discount Guideline.
• Return a completed Financial Assistance Application to Customer Service or any Patient Access registration desk. A determination is made within 30 days. You will receive a letter by mail or telephone call about eligibility.

Which Providers Participate?

• Most providers participate in the Financial Assistance Policy when services are performed at one of Augusta University Health’s locations. Please see FAP Provider Listing for a complete list of participating and non-participating providers.

For more information, call 706-721-1301.

Application Information

Please include the following documents with your completed Financial Assistance Application:

1. Proof of Residency in Georgia or South Carolina
   1. Driver's License or other identification issued by the State of Georgia or South Carolina; or
   2. Utility Bill showing street address (not a PO Box) and applicant's name
2. Proof of Income
   1. A copy of most recently completed and signed Federal Income Tax 1040A, 1040EZ, or 1040 with tax schedules
   2. A copy of pay stubs for the past three (3) months with year-to-date totals for all working family members
   3. If patient (or responsible party) did not file taxes the past year or if the income situation has changed, please provide copies of at least one of the follow documents to verify total family gross income (before deductions):
      1. A copy of or statement showing alimony, child support, rental income, interest, dividends, regular support payments, income from estates or trusts
      2. A dated and signed letter from employer on company letterhead stating amount of gross income per pay period and total number of hours worked per pay period
      3. Copy of checks or statement showing pensions, Social Security, Veteran’s Benefits, or Public Assistance. Temporary Assistance Needy Families (TANF) or Social Security Insurance (SSI) income received by any family members are excluded and will not be included in the calculation of total family gross income
      4. Copy of bank statement showing an "electronic deposit" from the federal government of Social Security or Veteran’s Benefits
      5. Statement showing Worker’s Compensation or Unemployment
      6. Copy of Food Stamps Summary
      7. Letter from Department of Family and Children Services or Social Security Office verifying income
   4. If patient (or responsible party) has no income or other means of support, please provide the following:
      1. Notarized Letter of Support from person(s) or entity providing your primary source of support for necessary living expenses
3. Proof of Expenses
   1. Copies of rent/mortgage, health insurance, medical bills/pharmacy report, and childcare. Please attach proof/copies of expenses listed above. Do not include any items which are deducted from your paycheck.

Please promptly return your income verification documentation in order to complete your financial assistance application. If you do not complete the financial assistance process you will be billed for outstanding hospital balances.

Send documents to:
Financial Counseling 
1120 15 St., BI 1010
Augusta GA 30912.

If you have any questions, please contact our Financial Counselor Line at 706-721-1301.