FAP Application Form
Dear siParadigm Patron,
Welcome to the bewildering world of healthcare billing. No doubt you are overwhelmed trying to get your arms around the logic of the bills you are receiving. The main reason for this complexity is that healthcare is a highly regulated business; and for a good reason to protect the consumer. Whereas discounts are common and welcomed in a free market, they are prohibited in a healthcare setting to ensure that service is based on good practice and not for any financial gains or “kickbacks”.
Therefore, siParadigm is committed to the highest level of compliance with not only the letter, but also the spirit of the regulations. In the meantime, we understand the difficulties of the billing process and are committed to making it “hassle-free”.
Our solution is the Financial Assistance Program. If our invoice presents ANY financial hardship to you, we will work directly with you to remove your hardship to your satisfaction.
To that end, if you have any questions regarding our bill or the Explanation of Benefits (EOB) that you received from your insurance, please contact us rather than your physician at 1 888 599 LABS (5227), Ext. 4003 or firstname.lastname@example.org. We are here to help you.
Financial Assistance for Underinsured Patients
siParadigm offers financial assistance to reduce out-of-pocket costs for qualified underinsured patients in the U.S., depending on their household income level. Examples of patients who are considered underinsured include:
To be eligible, patients must have insurance and meet the low income requirements (household incomes up to 400 percent of the Federal poverty level).
Financial Assistance for Uninsured Patients
siParadigm offers financial assistance to reduce out-of-pocket costs for qualified patients in the U.S. who do not have medical health insurance, depending on their household income level. To be eligible, patients must meet the low income requirements (household incomes up to 400 percent of the Federal poverty level).
A separate Application Form is required. The financial criteria below are for informational purposes only. This document need not be included with your application submission.