Patient Financial Assistance Program
The following minimum qualifications are required be considered for our Patient Financial Assistance program grant:
- Patient must be living and/or receiving treatment in our Metro Atlanta service area, which includes Cherokee, Clayton, Coweta, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Hall, Henry, Newton, Paulding, Rockdale and Walton counties.
- Patient must be at least 18 years old.
- Patient must be diagnosed with cancer and able to provide written documentation of the diagnosis from a healthcare provider.
- Patient must be in active treatment (chemotherapy, radiation therapy, hormone therapy, cancer-related surgery, etc.) or within a 12 month period following cancer treatment, and able to provide written documentation of treatment status from a healthcare provider.
- Patients who meet these qualifications are further screened for financial need in accordance with our guidelines.
Types of assistance provided
- Types of expenses ACCF grant award funds may be used for include utility bills; rent or mortgage; insurance premiums or co-payments; durable medical equipment not covered by insurance; lymphedema garments; pharmacy prescription costs; and transportation costs such as car payment, assistance with necessary repair costs, or gas card. Other expenses may also be eligible, subject to ACCF guidelines and Board approval. The standard grant award amount is determined by the ACCF Board of Directors, and may be changed at the discretion of the Board at any time based on available funding.
- Grant awards are once in a lifetime.
- Grant award payments are typically made payable directly to the company owed on behalf of the patient; grant recipient must supply a copy of the bill, late notice, mortgage statement, statement from landlord or other documentation necessary for ACCF to make grant payment. Grant awards are not paid in cash.
- Applicants must be referred by a healthcare professional (i.e., social worker, physician, physician assistant, nurse, or patient account representative) via a completed and signed Application for Patient Financial Assistance. The referring professional must be able to verify the patient's cancer diagnosis and treatment status as current or completed within the previous 12 months.
- If you are seeking assistance for yourself or a loved one, contact your oncologist or treatment facility and request a referral. Many providers in our service area have our application, or you can download it from this page.
- The application must be completed in full and signed by both the applicant and the referring professional. Applications may be submitted by fax to (678) 348-7523 or email to firstname.lastname@example.org. ACCF will review for eligibility and contact the patient for additional screening. Applications are generally processed within one business day of receipt.
Please be aware that ACCF does NOT:
- Provide transportation or make transportation arrangements
- Provide case management, social services or referrals
- Offer financial counseling or direct intervention with creditors
You may find the organizations listed on our Resources page to be helpful for some of these needs.