CO-PAY COST SHARE GRANT
The Family Care Center recognizes that there are potentially some barriers to keep clients from taking advantage of the benefits of TMS; one of those is the cost of co-pays per session.
In collaboration with the Colorado Veterans Health and Wellness Agency, a 501(c)3 Nonprofit professionally affiliated with the Family Care Center, we are able to provide an opportunity to apply for grant funded services to offset a significant portion of the cost of your co-pays.
If you are seeking financial assistance, please carefully read the entire contents of this page. It is imperative that you read each section before completing the online application at the bottom of the page.
Steps to the application process:
- 1. Read the guidelines and policies on this page thoroughly.
- 2. Read our Frequently Asked Questions
- 3. Complete the online application.
- 4. You will receive an email acknowledgement within 72 hours of receipt of your online application for financial assistance. If not received, please check your spam folder. Every application is responded to. If it is not in your spam folder then your email server has blocked the email.
- 5. You will need to provide the Colorado Veterans Health and Wellness Agency with the documentation and forms.
- 6. You can submit your required documents through the application form below, by sending an email to CVHWA@fccsprings.com or by faxing them to 719-540-2102, Attention: CVHWA GRANT
Once all of the required documents are received both from you and your provider, CVHWA will start the application review.
If your required documentation is not received within 2 days of your online application, the application will move from pending to closed status. You will have to reapply for assistance.
If you are seeking financial assistance, please carefully read the guidelines before applying:
CVHWA cannot assist with charges incurred prior to approval of application and receipt by the provider of the Acceptance Letter
CVHWA cannot pay for treatment in advance
CVHWA cannot pay a deposit
CVHWA cannot reimburse the applicant for payments made to the providers
CVHWA cannot pay on an invoice showing no balance due
CVHWA will only make payment to the provider’s office. Funds are never disbursed to an applicant
Please keep in mind, CVHWA can only assist qualified applicants and assistance is only provided with TMS treatment. This means that CVHWA does not provide assistance for routine office visits or other servics provided by the Family Care Center. If other services are needed or required, contact the CVHWA Grant Services Program.
You do NOT qualify for financial assistance through CVHWA under any of the following circumstances:
You are not a resident of the United States of America
You do not provide CVHWA with all the required documents
You have been approved for the entire amount needed by other means
You are seeking reimbursement for a paid bill
You are seeking reimbursement for a credit balance
You are seeking payment for an outstanding bill
Family Care Center has agreed to a payment plan with you
You are looking for help for other than TMS treatment
You cannot prove hardship
You have discretionary funds available that is greater than the total amount of co-pay
You cannot provide documentation you are a veteran
The following documents are required for all members of your household over 18 years old before your application can be reviewed.
Copy of your license or ID
Last two pay stubs
Your latest federal tax return for all members of your household showing the total amount of income
Copies of your last two bank statements for all members of your household from all of your bank accounts
If you are unemployed: a copy of your SSI or SSDI benefit letter or, proof of any federal or state assistance or, unemployment benefits letter or, W2 or 1099 from employer for all members of your household
Explanation of hardship (explanation why you cannot afford the treatment on your own)
For your protection – before sending any documents to CVHWA, please black out all occurrences of account numbers and/or social security numbers. Your privacy is of our utmost concern; all documentation received will be disposed of in a responsible manner. If your application is disapproved, no documentation will be retained. If your application is approved, only those documents indicating approval, agreements, and payments will be retained.