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

  • Specialty Care
  • Hospital/Medical Center
Hours
24 hours a day, 7 days a week
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 mail or hand deliver your completed application to one of the following locations, Attn: HOPE Program

Ascension St. Vincent’s Riverside
1 Shircliff Way
Jacksonville, FL 32204

Ascension St. Vincent’s Southside
4201 Belfort Rd
Jacksonville, FL 32216

Ascension St. Vincent’s Clay County
1670 St. Vincent’s Way
Middleburg, FL 32068

Ascension St. Vincent’s St. Johns County
205 Trinity Way
St. Johns, FL 32259

Contact Information for Financial Assistance Program
for Ascension St. Vincent’s Riverside, Southside, Clay County and St. Johns County 

Phone (904) 308-1956
Customer Service Representative will direct you to Financial Counselors
Fax Number (904) 308-5910

If you need assistance with Ascension Primary and Specialty Care,

please contact Ascension Medical Group (AMG) Financial Assistance Program at:

Phone Number: (904) 308-7864
Fax Number: (904) 450-6448

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