August 2009
Financial Assistance Procedure:
Uninsured patients will be provided with financial counseling, including assistance applying for local, state and federal health care programs such as Medicare and Medicaid
It is the policy of Shands Lake Shore to evaluate all uninsured patient’s ability to pay and offer financial assistance to those individuals who qualify.
Qualifying for financial assistance under Shands Lake Shore’s procedures involves the following:
1. Guarantors complete a financial statement application which details their income and expenses during the twelve (12) months prior to the hospital visit, as well as assets.
2. The financial statement application is reviewed for completeness. Supporting documentation may be requested from the Guarantor.
3. If the validated financial statement application and supporting documentation reflects an income at or below 300% of the most current Federal Poverty Level (FPL) for the stated family size, the account will be qualified for financial assistance (charity) in its entirety.
4. If the validated financial statement application and supporting documentation reflects a household income between 300% and 400% of the most current Federal Poverty Level (FPL) for the stated family size, a sliding scale will be applied and the account will be qualified for partial financial assistance (charity).
5. Financial assistance will not be granted for certain procedures and hospital programs where preferential package or elective pricing have already been taken into consideration for example, elective cosmetic surgery, in vitro fertilization and transplant programs.
6. Financial assistance will not be granted for individuals who are residents of other countries.
Should you have any questions regarding this information, please contact: (352) 265-0355 or (800) 342-5364
