Performance Orthopedics and Spine Specialty Hospital at Ascension St. Vincent’s
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Performance Orthopedics and Spine Specialty Hospital at Ascension St. Vincent’s

  • Orthopedics
Google maps location of Performance Orthopedics and Spine Specialty Hospital at Ascension St. Vincent’s

Address

4201 Belfort Rd 4th Fl
Jacksonville, FL 32216

Phone

904-296-5777

Hours

Open 24 hours a day, 7 day a week
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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 offers financial assistance to our patients for emergency and other medically necessary care. Our Financial Counselors help 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: 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/form4506-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 application 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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