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    Need help paying your bill? Let us know. At Ascension St. Vincent's, we understand that not all patients have insurance or the same financial circumstances. As part of our faith-based mission, we are dedicated to helping the most vulnerable and treating everyone with compassion, dignity and respect. We have a variety of discount programs and payment options, and trained financial counselors who can work with you one-on-one to understand your bill, your insurance coverage and assistance for which you may qualify. Please review our Financial Assistance Policy, also known as Health Outreach Patient Eligibility – H.O.P.E Program, linked below.

    These financial assistance documents cover services provided at:

    • Ascension St. Vincent's Riverside
    • Ascension St. Vincent's Southside
    • Ascension St. Vincent's Clay County
    • Ascension St. Vincent's St. Johns County

    Learn more regarding doctor's office billing at Ascension St. Vincent's. 

    Financial assistance documents

    • 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: emergency and medically necessary care

    Financial Assistance is limited to patients living in the Community defined as: 

    the five (5) counties of Northeast Florida which include Baker, Clay, Duval, Nassau, St. Johns and the ten (10) counties of Southeast Georgia which include: Appling, Bacon, Brantley, Camden, Charlton, Coffee, Glynn, Pierce, Ware and Wayne.

    Furthermore, some counties are limited to certain zip codes. Please contact our office if you have questions regarding the zip codes. 

    To help the Financial Assistance Application process move along, please submit the following with your completed and signed application:

    • Copies of 3 most recent paystubs from employer
    • Copies of most recent yearly tax return (if self-employed, include all schedules) or verification of non-filing (www.irs.gov/form 4506-T)
    • Social Security and/or Pension Retirement Award Letter
    • Parent or Guardian’s most recent yearly tax return, if applicant is a dependent listed on their tax form and under the age 25
    • Other income validation documents
    • Copies of bank statements from last 3 months
    • Copy of receipt of unemployment benefits

    Please note that incomplete applications/missing documents will cause delays in approval. We cannot process incomplete applications and without all required documents.

    Requirements for Financial Assistance Approval:

    • 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 print and mail your completed application and supporting documentation to the following addresses:

    Ascension St. Vincent's
    PO Box 932886
    Atlanta, GA 31193

    Ascension Medical Group
    PO Box 80278
    Indianapolis, IN 46240

    We are here to help and want to ensure that patients that qualify for financial assistance receive it. If you have any questions about this application, supporting documents required, or how to best get your application to us, please call one of our Patient Representatives at the following numbers:

    For support with the financial assistance program for Ascension St. Vincent’s Riverside, Southside, Clay County and St. Johns County, please call  904-308-7381.

    For support with the financial assistance program for Ascension Primary and Specialty Care provided by Ascension Medical Group (AMG), please call 904-308-7864.

    Our fax number is 904 450-6448.

     

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