Financial Assistance Program


InSource Diagnostics maintains a Financial Assistance Program which may waive a portion or all of the charges after determining that a patient is in need of financial assistance. Eligibility for financial assistance considers total income, number of members in the household, and certain monthly expenses.

Maximum Patient Responsibility*
Adjusted Household Gross Income
Household Size 0-$50,000 $50,001-$75,000 $75,001-$100,000 $100,001-$125,000 $125,001-$150,000 $150,001+
1 $20 $105 $215 $385 $470 $500
2 $0 $10 $125 $290 $375 $490
3 $0 $0 $30 $200 $285 $400
4 $0 $0 $0 $105 $190 $300
5+ $0 $0 $0 $15 $100 $210

 

*General guidelines for maximum "out-of-pocket" costs for ordered tests. Your specific individual costs may vary depending on your expenses - number of tests/year, mortgage/rent, auto payments, college tuition, and medical expenses. Please contact InSource Diagnostics Billing Department for a more detailed analysis of your financial responsibility.

ISD Financial Assistance Form

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231 W. Chestnut Ave. Monrovia, CA 91016
Office: (626) 386-5277 | Fax: (888) 677-7748 |
Email: info@InSourceDx.com

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