Financial Assistance Program

Samaritan is proud of our mission to provide high-quality, compassionate healthcare services to meet the needs of our civilian and military community. If you are worried that you will be unable to pay your bill in full, we may be able to help. You may qualify for discounts on medical expenses through Samaritan’s Financial Assistance Program if:

• You do not have health insurance
• Your health insurance does not cover all of the medical care you need
• You are not eligible for Medicaid or some other type of insurance*
• You meet the financial criteria

Download the Financial Assistance Program Application. Adobe Acrobat is needed to view and save this application. You may also view our Financial Assistance Policy for further information about this program.

If you have not recently applied for Medicaid/Family Health Plus, please sign the consent in section VI of the application, allowing us to exchange information with the Department of Social Services. In addition, income verification for the current time period – such as last 2 months wage statement and/or pay stubs will be needed to determine whether a New York State sponsored insurance application should be completed.

If you have any questions regarding the application or if you need help filling it out, please call our Financial Assistance Counselor at 315-785-4308. Please return the application to the attention of the Financial Assistance Program within twenty (20) days to the address below, or call the Business Office at 315-786-4900 for any further assistance. View our Financial Assistance Policy for further information about this program.