Home / Patients & Visitors / Financial Assistance
Financial Assistance
Policy & Charity Care
Tift Regional Health System (TRHS) is a not-for-profit organization dedicated to providing care for all patients, regardless of their ability to pay. We understand that some patients may not have the financial means to cover their medical bills.
- Our Financial Assistance Program offers free or discounted emergency and medically necessary services for those who qualify. Whether you’re uninsured or underinsured, our Financial Counseling team — along with a trusted third-party partner — can help you apply for government programs and complete the financial assistance application at no cost.
Approved applicants may receive reduced balances, full or partial forgiveness of charges, or other financial relief based on income and family size.
How to Apply
1. Download the Financial Assistance Application
Available in English and Spanish (PDF format).
2. Gather Supporting Documents
Include proof of income for all household members — such as pay stubs, tax returns, or benefit statements.
3. Submit Your Application
You can send completed forms and documentation by:
- Mail: Southwell Financial Assistance Office
- PO Box 807, Tifton, GA 31793
- Fax: (229) 353-6908
- Email (PDF Only): pfsfinancialcounselor@tiftregional.com
- In Person: At Tift Regional Medical Center or Southwell Medical
- Mail: Southwell Financial Assistance Office
4. Wait for a Response
Applications are reviewed promptly. You’ll receive a letter once your eligibility has been determined.
Need Help?
Financial Counselors are available to answer questions or help complete your forms.
- Call: (229) 353-6124, option 2 for assistance.
- Email: pfsfinancialcounselor@tiftregional.com
What's Not Covered
- Services not deemed medically necessary
- Elective or cosmetic procedures
- Physician or provider fees not employed by Southwell (see Appendix A list of non-covered providers)
- Accounts already placed with external collection agencies
- Non-residents of the hospital’s primary service area (when not receiving emergency care)
Financial Assistance Program and Application
- Choose your preferred language and download the form
- You can print and complete it by hand or fill it out electronically before submitting
Financial Assistance Application
Tip: You’ll need to include income verification documents with your application. See “How to Apply” for details.
Supporting Forms
These optional forms help provide additional documentation when required.
- No Income Statement (PDF) – Use this form if no one in your household has earned income.
- Self-Employment Income Statement (PDF) – For applicants who are self-employed.
- Marital Attestation Form (PDF) – Verifies marital status when applicable.
- Checklist for Financial Assistance (PDF) – Helps ensure your application is complete.
Policies and Notices
Southwell provides full transparency about its financial assistance policies.
- Financial Assistance Policy (FAP) – Full details on program rules and eligibility.
- Plain Language Summary (PDF) – Easy-to-read summary of our financial assistance policy.
- Billing & Collections Policy (PDF) – Outlines how we handle unpaid accounts.
- Provider Listing (Appendix A) – Lists providers not covered under the policy.
Need Copies or Help?
If you’d like printed copies of any forms or policies mailed to you at no charge:
- Call: (229) 353-6124, option 2 for assistance.
- Email: pfsfinancialcounselor@tiftregional.com
- Mail: Southwell Financial Assistance Office, PO Box 807, Tifton, GA 31793
2025 Financial Poverty Guidelines (PFG) Indigent/Charity Annual Income Levels
