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.
PSI has a quick online qualification tool available for you to determine if you may qualify for assistance before completing the application. Assistance is based on the your household income. Qualification criteria varies by program. Determine if you may qualify by using our Income Prescreening Tool.
INCOME PRESCREENING TOOL
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 fax, email, or mail this information to PSI. Please place your name and phone number on each page if faxed.
FAX: (804) 744-5407
MAIL: PSI PO Box 5930 Midlothian, VA 23112
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
- Baxter Hemophilia Co-pay/Co-insurance Assistance Pilot 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.
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.