Financial Assistance

Collect your documents

To find out if you are eligible for Spartanburg Regional’s Financial Assistance Program, you will need:

• Proof of income
  • Most recent year's tax return, including all applicable tax schedules
  • If you are claimed on someone else’s taxes, provide a copy of their tax return.
  • If you are employed but did not file a tax return, provide your three most recent pay stubs.
  • Social Security Administration letter, if applicable
  • Unemployment benefits statements, if applicable
• Proof of Assets
  • Provide the most recent month’s financial document to support any liquid assets. 

Apply online

The fastest and easiest way to apply for Spartanburg Regional’s Financial Assistance Program is in your MyChart patient portal. You can upload documents such as proof of income and answer all necessary questions as a part of the online application. 

 Start an application in MyChart

If you need to create a MyChart login or need help accessing your existing account, click here for MyChart assistance. 

Apply by mail/email

To apply for the Financial Assistance Program by mail or email:

• Step 1: Complete all fields on the following documents:
  • Financial Assistance Application 
    Download Financial Assistance Application 
    Download Application (Russian) | Download Application (Spanish) | Download Application (Ukrainian)
  • Asset questionnaire 
    Please provide the most recent month’s financial document (such as a bank statement) to support any assets listed. 
    Download Asset Questionnaire 
    Download Questionnaire (Russian) | Download Questionnaire (Spanish) | Download Questionnaire (Ukrainian)
  • Provider statement (if applicable) 
    If you have zero or limited income and someone else is helping you pay your monthly expenses, please have them complete a provider statement. This is a signed statement explaining monthly support from your provider with dollar amounts of the care that is provided to you. This includes room & board, personal expenses, etc.
    Download Provider Statement 
    Download Statement (Russian) | Download Statement (Spanish) | Download Statement (Ukrainian)
• Step 2: Once all forms are complete, please review for accuracy and gather all application information and documentation. Applications with missing information will be considered incomplete and will be denied. 
• Step 3: Submit your information one of two ways:
  • Email: [email protected]
  • Mail: 
    SRHS Patient Financial Assistance Program
    Patient Financial Services
    101 East Wood Street
    Spartanburg, SC 29303 

Once we receive your information, we will review your application to determine if you qualify for assistance. If there are special circumstances that affect your ability to pay, please include them with your application.

Your complete application will be reviewed by one of our Financial Counselors. You will receive a written decision promptly, usually within 30 days of submitting your application. If you are denied assistance, the reason for denial will be provided. If you are approved for partial assistance, the decision will also provide you with information on how to set up a payment plan. 

Spartanburg Regional Healthcare System is a charitable organization dedicated to providing care, regardless of ability to pay.

• Your financial circumstances will not affect the care you receive. All patients will be treated with respect and fairness.
• Assistance is available for medically necessary care. Patient may apply for financial assistance at any time during the continuum of care.
• If you have no health insurance and/or limited financial resources, you may be eligible for free or discounted services.
• The amount of financial assistance you receive is determined by SRHS’s Financial Assistance Guidelines.
• Depending on the amount of your bill and your financial circumstances, minimum monthly payments may be accepted with no interest charged.
• If you do not qualify for financial assistance but believe you have special circumstances, you can request that your case be reviewed by a SRHS Business Services Supervisor / Financial Counselor.
• If you apply for financial assistance, you must provide us with all information necessary to apply for other financial resources that may be available to you, such as Medicaid or Medicare.
• You are responsible for applying for financial assistance. SRHS will make application materials easily available. To request an application call 864-596-1001 or 800-281-5346. Additionally, you may download the form here.
• You may qualify for financial assistance if your household income is less than or equal to 2 times (200%) of the current Federal Poverty Guidelines.
• You may qualify for partial financial assistance depending upon your household income and the number of members in your family. This is also based on the U.S. Government’s Federal Poverty Guidelines.
• You may qualify for presumptive financial assistance if you are covered by a limited Medicaid plan, covered by another assistance program such as Access Health or John Fleming Cancer Care. You may also qualify for presumptive financial assistance if clinical and diagnosis notes indicate unstable housing.  

If you have questions or need help completing the form, call Spartanburg Regional Healthcare System Patient Financial Services at 864-596-1001 or 800-281-5346.