Financial Assistance
If you’re uninsured or have trouble paying for healthcare, Ascension may be able to help through our financial partnerships and resources.
Ascension St. Vincent’s Financial Assistance Program, also known as Health Outreach Patient Eligibility – H.O.P.E Program aims to improve access to medical care for all individuals. We offer assistance with:
- Florida and Georgia Medicaid application
- Financial Assistance /HOPE application
- Financial Counseling and Payment arrangements
- Finding medical resources
- Other state and federally funded assistance programs
Care covered by Financial Assistance and Community Served
Please refer to our Charity Care Policy.
Financial Assistance/HOPE Application Checklist
- To help HOPE application process move along, applicants are encouraged to submit completed, signed and dated applications along with required documents. We cannot process incomplete applications.
- Uninsured are required to work with a financial counselor to apply for Medicaid or other eligible programs to qualify for financial assistance
- Approval is subject to the assurance that you will apply for and assign to our facilities any benefits available from insurance, liability insurance (PIP/Bodily Injury), Medicare, Medicaid, or public assistance as a result of our service provided to you. All other funding sources not limited to those listed above and including settlement funds take precedence to financial assistance.
- Additional information and/or documentation may be required to complete your application. All information is subject to verification.
- Providing false information may result in a denial of any type of financial assistance.
Please mail or hand deliver your completed application to one of the following locations:
Ascension St. Vincent’s Riverside
HOPE Program
1 Shircliff Way
Jacksonville, FL 32204
Ascension St. Vincent’s Southside
HOPE Program
4201 Belfort Road
Jacksonville, FL 32216
Ascension St. Vincent’s Clay County
HOPE Program
1670 St. Vincent’s Way
Middleburg, FL 32068
Contact information for Ascension St. Vincent’s Riverside, Southside and Clay HOPE Program:
Phone (904) 308-1956
Customer Service Representative will direct you to Financial Counselors
Fax Number (904) 308-5910
Ascension Medical Group (AMG) HOPE Program:
We offer assistance with HOPE application for Ascension Primary and Specialty Groups. If your approval is through AMG , please contact:
AMG Contact Information:
Phone Number: (904) 308-7864
Fax Number: (904) 450-6448
English
- Financial Assistance/Hope Application
- Plain Language Summary of Financial Assistance Policy
- List of Providers Covered by the Financial Assistance Policy
- Charity Care Policy
- Amount Generally Billed Calculation
Arabic ( عربى)
- لمساعدة المالية/HOPE طل
- ملخص سياسة المساعدات المالية
- قائمة موفري الرعاية الذين تغطيھم سياسة المساعدات المالية
- سياسة المساعدة المالية والخصومات لغير المؤمن عليھم والمؤمن عليھم بشكل غير كافٍ
- Amount Generally Billed Calculation
French (Français)
- Formulaire de demande d’aide financière/HOPE
- Résumé de la Politique d’aide financière
- LISTE DES PRESTATAIRES PRIS EN CHARGE PAR LA POLITIQUE D’AIDE FINANCIÈRE
- Politique d’aide financière et de réduction pour les personnes non assurées ou sous-assurées
- Amount Generally Billed Calculation
Haitian-French Creole (Kreyòl Ayisyen)
- Aplikasyon HOPE/ pou asistans finansyè
- Rezime Politik Èd Finansyè a
- LIS PWOFESYONÈL SWEN SANTE KI GARANTI ANBA POLITIK ÈD FINANSYÈ
- Politik Èd Finansyè ak Rabè pou Moun ki pa gen Asirans ditou oswa ki pa gen bon Asirans yo
- Amount Generally Billed Calculation
Portuguese (Português)
- Assistência financeira/Requerimento HOPE
- Sumário da Política de Assistência Financeira
- LISTA DE PROVEDORES COBERTOS PELA POLÍTICA DE ASSISTÊNCIA FINANCEIRA
- Assistência financeira e política de desconto para não-segurados ou segurados por valor inferior
- Amount Generally Billed Calculation
Russian (русский)
- Заявление на финансовую помощь/HOPE
- Краткое содержание «Политики финансовой помощи»
- СПИСОК ПОСТАВЩИКОВ, НА УСЛУГИ КОТОРЫХ РАСПРОСТРАНЯЕТСЯ ПОЛИТИКА ПРЕДОСТАВЛЕНИЯ ФИНАНСОВОЙ ПОМОЩИ
- Политика предоставления финансовой помощи и скидок для незастрахованных или застрахованных ниже действительной стоимости лиц
- Amount Generally Billed Calculation
Serbo-Croatian (Srpsko-hrvatski)
- Zahtev za finansijsku pomoć/HOPE zahtev
- Sažetak Politike finansijske pomoći
- POPIS PRUŽATELJA KOJE OBUHVAĆA POLITIKA FINANSIJSKE POMOĆI
- Pravilnik o novčanoj pomoći i popustu za neosigurane ili nedovoljno osigurane osobe
- Amount Generally Billed Calculation
Simplified Chinese
Spanish (Español)
- Asistencia Financiera/Solicitud HOPE
- Resumen de la Política de Asistencia Financiera
- LISTA DE PROVEEDORES CUBIERTOS POR LA POLÍTICA DE AYUDA FINANCIERA
- Política de ayuda financiera y descuentos para personas no aseguradas o con seguro insuficiente
- Amount Generally Billed Calculation
Tagalog (pilipino)
- Tulong-Pinansyal/Aplikasyon para sa HOPE
- Ang Buod ng Patakaran sa Tulong Pampinansiyal
- LISTAHAN NG MGA PROVIDER NA SAKLAW NG PATAKARAN SA TULONG-PINANSYAL
- Patakaran sa Tulong-Pinansyal at Diskwento para sa mga May Insurance o Kulang ang Insurance
- Amount Generally Billed Calculation
Traditional Chinese
Vietnamese (Tiếng Việt)