North Jefferson County Ambulance District offers financial assistance to make healthcare affordable and accessible to all members of our community. We also provide discounted and charity care for eligible individuals. If payment of your healthcare expenses could create a financial hardship for you, our Patient Accounts staff will work with you to apply for financial assistance.
The information you provide is confidential and is only reviewed by staff processing your application.
Eligibility for financial assistance is based on:
- Household income, in relation to federal poverty guidelines
- Any additional financial hardship
- Medically necessary care
- The account must be a current, non-collection-referred account
How to Apply for Financial Assistance
To apply please complete an application for financial assistance. Along with the application, you must submit all of the following documents;
- Copies of most current W-2’s for each household member(s).
- Copies of most current Federal Income Tax Return for each household member(s).
- Copies of the three most recent, paycheck stubs or a statement of earnings from the employer for each household member.
Please provide the following documents if applicable;
- Copies of unemployment and/or disability compensation statements for each household member.
- Copies of social security or pension benefits income for each household member.
- Copies of government assistance notices, such as Social Security Disability and Medicaid Programs for each household member.
All of these materials must be submitted with your application. Incomplete applications will not be processed. We can help you prepare, complete, and submit your application.