Weeks Health Access—Financial Assistance
Weeks Health Access is a local financial assistance program to help you with the care you need when you need it most. Patients who meet criteria for participation can receive help with their medical bills for services received at Weeks Medical Center facilities. In addition, if patients further qualify, they may also enroll in our Pharmaceutical Assistance Program, which can provide needed medications at greatly reduced prices. For complete guideline information: Weeks Health Access/NH Health Access Program.
Patients living in our catchment area:
- In New Hampshire: Lancaster, Whitefield, Dalton, Randolph, Jefferson, Groveton, Stark, Stratford, Twin Mountain, Bretton Woods, Bethlehem, Carroll, Northumerbland.
- In Vermont: Gilman, Granby, Guildhall, Lunenburg, Maidstone, Brunswick, Bloomfield.
- Patients residing in a community considered part of Weeks secondary catchman are: Bethlehem, Dummer, Odell, West Milan, Brunswick, VT, Victory, VT, and Concord, VT.
- Those who have a Weeks Medical Center provider as their regular doctor, regardless of where they live.
- Patients who receive emergency treatment for life-threatening illness or injury.
How to apply.
Follow these steps:
- Complete financial forms: Financial Assistance application page 1 and page 2 (PDF)
- Submit forms, including NHHA Checklist (PDF) and Release of Information (PDF) with copies of income (paycheck stubs, Social Security benefit statement)
- Submit copy of a recent tax return
- Submit a copy of liquid assets (checking and or savings account statement, Certificates of Deposits, etc.). If necessary, please submit: Verification – No Bank Account (PDF) and No Income Support Verification (PDF)
- Sign IRS Form 4506T Release 4506T, IRS (PDF)
Is there a cost to me?
There may be a co-pay for medical care or handling charge for the Pharmaceutical Assistance Program. The amount is based on your income and assets. You are expected to present the co-pay at the time you receive service.
What help can I get?
- Bills incurred at Weeks Medical Center for non-elective services with the hospital or doctor’s office (lab, x-ray, room charges)
- Doctor bills for providers employed by Weeks Medical Center
- Weeks applies on your behalf to the drug companies for help with medications. Each company has its own criteria; therefore, approval for participation in the WHA program does not guarantee approval by the pharmaceutical companies.
For further information, please call the Weeks Medical Center Business Office at 603-788-5354.