Have A Question About Your Eligibility Status?

Complete the form below and one of our advocates will be in touch with you shortly.

Before You Reach Out...

As of October 2019 APA is now part of Kemberton. If you have not been referred to APA-Kemberton, we recommend that you contact the Patient Financial Services department at your healthcare provider. We work directly with health care providers so they may be able to assist you in evaluating insurance coverage options and refer you to other resources that can help, such as APA-Kemberton.
 

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First Name

Last Name

Email

Phone number

Hospital or facility where you received services

Questions & Comments

Date of Birth

What state do you live in? - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Are you older than 64 or younder than 19 years of age?

Yes

No

Are you pregnant or have you been pregnant within the past 60 days?

Yes

No

Do you have a child under the age of 19 living in your home?

Yes

No

Do you currently receive disability benefits from the Social Security Administration?

Yes

No

Do you have an illness or injury that prevents you from working for an extended period of time?

Yes

No