Home > For Patients  >  Apply
APPLY FOR ASSISTANCE

Applying for assistance should not require hours of endless paperwork. At PSI, we respect your personal time and know that spending time with family and friends is what really matters. That's why we've created a quick online application process that is user friendly and easy to complete. The PSI family is committed to meeting your needs as quickly as possible! Applying for PSI assistance online allows for quicker processing of your request and as an added benefit, helps our environment by reducing paper use.

To be considered for assistance, you must complete an application. You will need the following information available to complete the online application for financial assistance in a disease specific program:   

  • Diagnosis and type of assistance requested
  • Demographic and contact information
  • Income information
  • Health insurance information  

Documentation of household income (i.e. tax return) is needed to complete your application. You may upload your income through your portal account. If you have not created an account yet, please click here to start the process. 

Some programs require additional information from your physician. A completed Medical Care Provider Statement is required to process the following PSI applications:
  • Breast Cancer Screening program
  • Metastatic Renal Cell Carcinoma Incidental Expenses (IE) program
  • Premium assistance programs

Once you have completed and submitted the online portion of your application, a confirmation message will display. You will also receive a confirmation email if you provide this information in your application. An email address will help PSI to provide you with information to your account through our patient portal.  

After all required documentation is received, your application will be processed based on our eligibility criteria and the information you provided.

APPLY NOW

If you are unable to complete the application online, you can call PSI directly at 1 (800) 366-7741 to start your application over the phone.