Patients and Visitors

Weeks Health Access is a local financial assistance program to help you with the care you need when you need it most. Patients who meet criteria for participation can receive help with their medical bills for services received at Weeks Medical Center facilities. In addition, if patients further qualify, they may also enroll in our Pharmaceutical Assistance Program, which can provide needed medications at greatly reduced prices.

Who qualifies?

• Patients living in our catchment area:
• In NH: Lancaster, Whitefield, Dalton, Randolf, Jefferson, Groveton, Stark, Stratford, Twin Mountain, Bretton Woods, Bethlehem, Carrol.
• In VT: Gilman, Granby, Guildhall, Maidstone, Brunswick, Bloomfield.
• Those who have a Weeks Medical Center provider as their regular doctor, regardless of where they live.
• Patients who receive emergency treatment for life-threatening illness or injury.

How to apply.

• Complete financial forms
• Submit forms with copies of income (paycheck stubs, Social Security benefit statement)
• Submit copy of a recent tax return
• Submit a copy of liquid assets (checking and or savings account statement, Certificates of Deposits, etc.
• Sign IRS Form 4506T
• Financial Assistance Application (PDF)
• NHHA Checklist (PDF)
• Release 4506T, IRS (PDF)
• Release of Information (PDF)
• Verification - No Bank Account (PDF)
• Verification Support (PDF)

Is there a cost to me?

There may be a co-pay for medical care or handling charge for the Pharmaceutical Assistance Program. The amount is based on your income and assets. You are expected to present the co-pay at the time you receive service.

What help can I get?

• Bills incurred at Weeks Medical Center for non-elective services with the hospital or doctor’s office (lab, x-ray, room charges)
• Doctor bills for providers employed by Weeks Medical Center
• Weeks applies on your behalf to the drug companies for help with medications. Each company has its own criteria; therefore, approval for participation in the WHA program does not guarantee approval by the pharmaceutical companies.

For further information please call the Weeks Medical Center Business Office: 603-788-5354