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 2018 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 12,141 12,142 15,176 15,177 18,212 18,213 21,247 21,248 24,282
2 0 16,460 16,461 20,575 20,576 24,690 24,691 28,805 28,806 32,920
3 0 20,780 20,781 25,975 25,976 31,170 31,171 36,365 36,366 41,560
4 0 25,100 25,101 31,375 31,376 37,650 37,651 43,925 43,926 50,200
5 0 29,420 29,421 36,775 36,776 44,130 44,131 51,485 51,486 58,840
6 0 33,740 33,741 42,175 42,176 50,610 50,611 59,045 59,046 67,480
7 0 38,060 38,061 47,575 47,576 57,090 57,091 66,605 66,606 76,120
8 0 42,380 42,381 52,975 52,976 63,570 63,571 74,165 74,166 84,760
% 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