Pricing Estimates and Information

Our Patient Benefit Advisors are available to evaluate your eligibility for various local and state programs, including county assistance and Medicaid. You can reach our advisors by calling 800-370-1983.

Financial relief may be available to patients who have received non-elective care, do not qualify for state or federal assistance and cannot establish partial payments or pay their balance. In most cases, this will apply to patients who fall between 0 and 200% of the Federal Poverty Level. Federal Poverty Levels based on total household income, with sufficient supporting documentation provided by the patient, will have a 100% charity discount processed.

For patients with balances greater than $1,500 and whose documented income is between 201 and 400% of the Federal Poverty Level, we have an expanded financial assistance policy that may reduce the amount you owe. To determine if non-elective services you received could be eligible for either full or partial charity, please contact our hospital for details on how to know if you're eligible to receive assistance.

Some locations may have identified additional criteria for charity eligibility besides the Federal Poverty Levels (i.e., high medical costs, more lenient income levels, etc.). To verify your eligibility for assistance under this policy, we recommend you contact our hospital.

Our hospital must complete a validation to ensure that the payment has been received and posted to the account if any portion of the patient's medical services can be paid by:

• Any federal or state health care program (e.g., Medicare, Medicaid, Champus, Medicare secondary payor)
• A private insurance company
• Another private, non-governmental third-party payor

No charity discount can be applied to any account with any outstanding payer liability.

All Medicare accounts and all non-Medicare inpatient accounts will be required to have supporting income verification documentation. Medicare requires independent income and resource verification for a charity care determination for Medicare beneficiaries (PRM-I § 312).

All self-pay patients, excluding elective cosmetic procedures and facility-designated self-pay flat-rate procedures, will receive a discount similar to managed care, referred to as an "uninsured discount". This discount is limited to patients who have no third-party source of payment or do not qualify for Medicaid, Charity or any other discount program the facility offers. The discount amount offered may vary by location based on state requirements, patient income levels and local rates.

At the time of service, patients will be asked to make payment in full or establish monthly payment arrangements on the patient liability amount.

Patients confirmed to be uninsured (or their responsible party) will be presented with an Uninsured Patient Information document that provides information on the Uninsured Discount Policy and other available discounts and payment options. This document will outline the process for uninsured discounts and inform the patient of additional account resolution options (i.e., monthly payments). The patient/responsible party will be asked to sign and date the document at the time of service.

Similar to your visits to your physician's office, we request payment at the time of service or when you pre-register. If you are ineligible for Medicaid or financial assistance and cannot pay your entire estimated bill, we will work with you to set up payment arrangements. If, after your services are received, any additional payment is due, we will send you information about any amount you may still owe. We accept all major forms of payment.

Before calling, please contact your physician's office to get the specific diagnosis or procedure description.

When you call our Service Center, please have the following information available, so that we can provide you with the most accurate estimate possible:

• Description of services needed: We will need to know as much information as possible about the specific services as described by your physician.
• Type of services needed: We need to know if you will be admitted to the hospital as an inpatient overnight or if you are expected to be treated on an outpatient basis.
• Physician/specialist name: For example, if you are having surgery, we will need to know the surgeon's name.

The estimates provided are only related to your hospital bill. Your personal physician or other physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists and radiologists.

Independent laboratory and radiology services will also bill you separately for reading and interpreting EKGs, X-rays, EEGs and lab work. If you have questions about those bills, please call the number printed on their statements.

When you have made an informed decision and are ready to proceed with services at our facility, you should contact your physician's office to ask to have your service scheduled.

Pre-registration is available to all scheduled patients prior to the date of service and expedites the admission process. All registration information will be obtained over the phone.

When you arrive at the facility, you will be required to provide your identification, finalize financial arrangements and sign a few forms before going to the department.