FINANCIAL ASSISTANCE PROGRAM

It is the Financial Assistance Policy of Southwest Diagnostic Imaging Ltd. and its affiliates, EVDI Medical Imaging, Scottsdale Medical Imaging, and Valley Radiologists., to render services at a reduced amount to patients who are not able to pay for services and who are not eligible for outside financial aid or government healthcare programs.

Financial Assistance is the payor of “last resort” for services provided by Southwest Diagnostic Imaging Ltd. and its affiliates, EVDI Medical Imaging, Scottsdale Medical Imaging, and Valley Radiologists. Assistance determination is made based on the patient’s or responsible party’s net income (after medical expenses), number of members in the household, and net worth. To speak to a Financial Counselor please call (602) 521-6203. To download an application form click here.

A consistent sliding discount scale for patient liability will be applied after assessing patient financial need. The monthly income limit for most Arizona programs is 100% of the Federal Poverty Level (FPL). Refer to the Financial Qualification Scale for details and to serve as a guide in offering Financial Assistance:

Based on 2015 Federal Poverty Guidelines
HHS Website for obtaining program fiscal year poverty guidelines is located at http://aspe.hhs.gov/poverty/index.shtml
Family Size 100 % Discount* 80% Discount 60% Discount 40% Discount 20% Discount
Above Below Above Below Above Below Above Below Above Below
1 0 11,670 11,671 14,588 14,589 17,505 17,506 20,423 20,424 23,340
2 0 15,730 15,731 19,663 19,664 23,595 23,596 27,528 27,529 31,460
3 0 19,790 19,791 24,738 24,739 29,685 29,686 34,633 34,634 39,580
4 0 23,850 23,851 29,813 29,814 35,775 35,776 41,738 41,739 47,700
5 0 27,910 27,911 34,888 34,889 41,865 41,866 48,843 48,844 55,820
6 0 31,970 31,971 39,963 39,964 47,955 47,956 55,948 55,949 63,940
7 0 36,030 36,031 45,038 45,039 54,045 54,046 63,053 63,054 72,060
8 0 40,090 40,091 50,113 50,114 60,135 60,136 70,158 70,159 80,180
% of Poverty 100% 125% 150% 175% 200%
Plan Code 904 903 902 901 900

For Family Units with more than 8 members, for each additional member add $4,060.
Patients under 100% FPL may be charged an administrative fee up to $25