Singing River Health System is a public health system owned by Jackson County, Mississippi. The Financial Assistance Program procedures are designed to assist individuals who qualify for less than full coverage under available federal, state and local medical assistance programs, but for whom residual “self-pay” balances exceed their own ability to pay.
Patients have 240 days from discharge to submit an application for financial assistance.
In order for us to determine financial assistance eligibility, we will need the following information returned to our office.
Proof of Income
Our office will determine financial assistance eligibility using the following specific document types only. Please submit two (2) of the following for each family member along with your application to ensure timely processing of your application.
- A complete copy of your most recent Federal Tax Return, including all W-2 and/or 1099 forms; self-employed must include a Schedule C.
- Award letter indicating the amount you receive from social security and/or disability.
- Most recent bank statement reflecting deposit of social security, disability, alimony, child support, retirement, benefits, Pensions, Worker’s Comp, and/or unemployment by an electronic check.
- Most current paystub to include year-to-date wages.
- If separated, please provide divorce document and/or a notarized letter of separation.
- If unemployed, please submit a letter verifying length of unemployment.
- If someone is helping you with your expenses such as rent or food, a letter from that person is required.
Proof of Residency
To qualify for financial assistance, patient must be a resident of Jackson, Harrison, Hancock, George, or Stone County. Please submit one (1) of the following documents as proof of residency. Residency documents must be in the applicant’s name or the applicant’s spouse’s name and contain a physical address. No post office box may be used as proof of residency.
- Current driver’s license
- Car tag registration
- Mortgage papers, lease or rental agreement
- Homestead exemption receipt
- Voter registration card
- Water or electric bill
To apply for financial assistance, patients must submit a complete application with a signed consent form allowing Singing River Health System to pull their credit report. The credit report will result in a soft hit, which has no adverse effect towards the patient’s credit score.
All information will be verified. An incomplete application will be denied. Patients have 240 days from discharge to submit an application for financial assistance.
Obtain an application form at any of our hospitals, apply online through MySingingRiver, or download the files you need below.
Download Application Files
- Financial Assistance Policy and Procedure – Gulfport (PDF)
- Financial Assistance Policy and Procedure – Jackson County (PDF)
- Application Instructions (PDF)
- Application (PDF)
- Reglamento y Procedimiento del Programa de Ayuda Económica (PDF)
- Ayuda Económica (PDF)
- Solicitud (PDF)
If you have questions about the Financial Assistance Program or the application process, call Financial Services at (228) 762-8876.