FINANCIAL ASSISTANCE

The Pink Bridge Program is a financial assistance program offered to breast cancer patients who are in ACTIVE TREATMENT, providing financial assistance for medical and certain living expenses. Grants range in values up to $2,500 based on the availability of funds AND the needs of the applicant.

• Please understand we are not an emergency fund and cannot provide immediate assistance.
• Meeting the guidelines and applying to the Pink Bridge Program does not guarantee funds will be available or offered.

To lessen the financial burden during treatment, the Pink Bridge Program provides funding for:

• medical expenses, not covered by insurance
• rent or mortgage payments
• utility bills (electricity, gas, water)
• gas and grocery assistance

The Pink Bridge funding does not assist with cable/internet bills, insurance premiums, car payments, phone/cell phones, or medications.

To qualify for Pink Bridge funding:

• The applicant must be a US citizen and Georgia resident living in, or being treated in, the Central Georgia area.
• Patient must have a breast cancer diagnosis and be in active treatment.
  • Active treatment includes chemotherapy, radiation, surgery, reconstructive surgery, hospice, or palliative care.
  • Patient meets the financial guidelines and criteria set by United in Pink.

Hormone and maintenance therapy is not considered “active” treatment for the Pink Bridge Program.

Only completed applications submitted will be considered for funding. Application must be printed and MAILED for review.

Click here to complete an application.

• Patient must download, complete, and mail the application. For the protection of your confidential information, all documents supporting your application must be MAILED. We cannot accept an application via email.
• Your doctor’s office needs to complete the Medical Information Form to confirm the breast cancer diagnosis.
• A release form must be signed by the patient.
• Patient must submit:
  • Financial Statement (page 5)
  • Last 2 pay stubs or proof of unemployment. If income is solely Social Security or Social Security Disability Income, then a copy of your statement or letter. This shall include copies of any unemployment or stimulus payments.
  • Copy of bill(s) being submitted for reimbursement.
  • Copy of driver’s license or alternate ID
  • If insured: copy of current insurance, Medicare, and supplemental cards (front and back)
  • If uninsured: copy of Medicaid and/or social security, disability rejection letters
  • Statement of Need/Your Story

Applications are reviewed monthly and you will be contacted by our Financial Administrator upon receipt of your application for a timeline. Typically, you will be notified within 6 weeks of approval or denial.

• Review all the FAQs and requirements before beginning the application
• Have all required documents
• Provide the medical release form to your healthcare provider
• Provide copies of lease, mortgage payments and bills requesting payment for
• Read and follow all instructions carefully
• Be thorough in all responses and help us better understand your journey with breast cancer
• Call if you have any questions with application

Click here to request a gas or grocery card with an explanation of need.