Financial assistance may be available to patients who (i) reside in the states of Georgia, Alabama, Florida, North Carolina, South Carolina or Tennessee, and (ii) received emergency or medically necessary health care services at a Northside Facility. Medically necessary services are inpatient or outpatient health care services provided for the purpose of evaluation, diagnosis and/or treatment of an injury, illness, disease or its symptoms which, if otherwise left untreated, would pose a threat to the patient’s ongoing health or well-being. Each request for financial assistance will be reviewed independently and allowances may be made for extenuating circumstances on a case-by-case basis.
To be considered for financial assistance under Northside’s Financial Assistance Program, a patient may be screened verbally prior to admission over the phone or in the emergency department, or a patient must complete Northside’s Financial Assistance Application, attached here and available at http://www.northside.com/billingandcollections and provide Northside with financial and other information necessary to support a patient’s eligibility for financial assistance. More specifically, patients will be required to provide proof of residency in one of the following states: Georgia, Alabama, Florida, North Carolina, South Carolina, or Tennessee. Additionally, patients may be asked to provide, if applicable:
Note: Patients will be asked to manually redact their SSN on any copy of supporting documentation. If personnel receive copies of supporting documentation that contain patients’ SSN, they will black out the SSN.
After receiving a patient’s application for financial assistance and supporting financial information or other documentation needed to determine eligibility for assistance, Northside will provide written notification regarding the determination within thirty (30) to sixty (60) days of receiving the request. Incomplete applications will be denied and a letter indicating what information is missing will be sent to the applicant. Upon receipt of the missing information, Northside will reconsider the application. Applicants may appeal denials of financial assistance by submitting an appeal request in writing. An appeal form will be included with the letter denying financial assistance.
In the event that a patient needs services on an urgent basis, Northside will work with the patient process any such request for financial assistance on an expedited basis.
Northside will offer financial assistance adjustments to patients who meet the established Financial Assistance Program guidelines and have completed the appropriate application. Additionally, Northside may discuss with patients the availability of government or other assistance programs as appropriate and assist patients in evaluating their eligibility for such programs.
Patients who present with Out of State Medicaid coverage for services via the Emergency Department are eligible to receive a full discount on care.
Patients with annual household income less than or equal to 300 percent of the Federal Poverty Income Level may qualify to receive a full discount on care if they meet Northside’s Financial Assistance Program guidelines. Income, assets, debt and expenses will be evaluated for financial assistance approval. Patients who are insured or have a third party liability claim are only eligible to apply for financial assistance in the event they have a remaining balance after all payment resources are exhausted. Additionally, Northside may, within its discretion, fully discount care for medically indigent patients, whose medical or hospital bills from all related and unrelated health care providers, after payment by all third-party sources, would cause the Patient significant financial hardship.
Additionally, in certain instances and within Northside’s discretion, Northside may utilize a third-party to help identify patients that qualify for financial assistance based on publicly available patient information (e.g., participation in state-funded prescription programs, participation in the Women, Infants and Children (WIC) program, participation in the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), subsidized school lunch program eligibility, or eligibility for other state or local assistance programs). Patients identified as eligible to receive financial assistance by a third-party will not be required to complete the Financial Assistance Application.
All financial assistance approvals will continue to be valid for six (6) months, unless a change in the patient’s circumstances would void their eligibility. Additionally, Northside may request information to confirm that a patient’s financial circumstances continue to meet the Financial Assistance Program guidelines.
Please note that Northside will treat all applications, supporting documentation, communications and information obtained by third-parties with the highest regard for patient confidentiality.
Northside does not charge any patient that qualifies for financial assistance more than Amounts Generally Billed (“AGB”).
AGB is calculated by multiplying the full price for medical care that is uniformly applied for services, before contractual discounts or deductions (“Gross Charges”), by the AGB percentage.
If a patient is responsible for all or part of the cost of services received at a Northside Facility, Northside will attempt to bill and collect from the patient.
Certain services provided at a Northside Facility by a physician, physician assistant, nurse anesthetist or other professionals are not covered under Northside’s FAP. Specifically, services provided in the following departments by the following providers, are not covered by the Financial Assistance Program:
Northside will widely distribute this policy to the public by posting a copy on Northside’s website and posting a copy in Northside’s Emergency Departments, registration areas and waiting rooms. Northside will also include a reference to the link on the website where the policy and application can be found in the pre-admission welcome letter. Additionally, Northside’s Financial Assistance Application and appeal form may be obtained by:
Contacting or visiting one of Northside’s Financial Counseling Offices between the hours of 9:00 a.m. and 4:00 p.m., Monday through Friday:
Northside Hospital Business Office
Attention: Financial Assistance
1001 Summit Blvd NE Suite 150
Atlanta, Georgia 30319