Manage your bill at Ascension St. Vincent’s in Florida
If you have trouble paying for healthcare, connect with Ascension St. Vincent's in Jacksonville, Florida to find out how we can help you access care.
Financial Aid for Your Medical Group Bill
At Ascension hospitals and clinics, patients receive necessary medical care, regardless of their ability to pay. Services are provided without regard to culture, age, gender, sexual orientation, spiritual beliefs, socioeconomic status, language or disability. Trained financial counselors are available to discuss individual needs. We will review your eligibility for financial assistance and assist you in making payment arrangements.
If you feel you need financial assistance, please print and complete the financial assistance application form below:
Our mailing address for completed forms:
Ascension Medical Group
P.O. Box 80278
Indianapolis IN 46240
Additional income, asset and expense information may be requested upon review of the completed financial assistance application.
Financial counselors are available Monday through Friday 8 am – 4:30 pm. For additional assistance please contact a counselor associated to the location where services were performed.
Contact Us
Hours
Monday-Friday
8 am-4:30 pm
Ascension Medical Group
833-263-9780
For additional information about the financial assistance policy or an application form, view the documents below:
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
- حساب المبلغ المدفوع بصفة عامة
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
- Calcul du Montant Généralement Facturé
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
- Kalkil Jeneral Kantite Lajan Pou Mete Nan Bòdwo
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
- Cálculo Do Valor Normalmente Faturado
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
- Расчет Обычно Выставляемых Сумм
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
- Obračun Iznosa Koji Se Obično Naplaćuje
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
- Cálculo De La Cantidad Facturada Por Regla General
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
- Kalkulasyon Ng Halagang Karaniwang Sinisingil
Traditional Chinese
Vietnamese (Tiếng Việt)