South Limestone Hospital District Financial Assistance Policy Summary

Eligibility

South Limestone Hospital District offers reduced or no-charge services for all emergencies or other medically necessary care for individuals eligible under our Financial Assistance Policy (FAP). No one will be denied access to services due to an inability to pay; and there is a discounted fee schedule available on family size and income. Eligibility is based on the hospital’s Financial Assistance Policy, which includes using the Federal Poverty Guidelines, number of dependents and gross annual income along with supportive income documents. Additional means of determining eligibility may be utilized by the hospital if individual circumstance supports that a completed application is not practical.

Income guidelines

You may qualify for the hospital financial assistance program if the family’s annual gross income is less than or equal to 200% of the federal poverty level, based off the federal poverty guidelines. Eligible individuals will not be charged more than amounts generally billed. The hospital will use the Prospective Method to determine the allowed amount to be applied to gross charges to determine the generally billed amount to be considered for financial assistance. The detail of this information is available upon request by calling the Business Office at 254-729-3281.

Collection Procedures

Normal collection procedures will be followed for all patients unless the hospital’s Financial Assistance Application Form is completed and submitted to the hospital. Patients with incomplete applications will receive written notification identifying the additional information and the final date information or payment must be received to prevent submission of an account to an outside agency for collection.

Information on Obtaining the Hospital Financial Assistance Application Form and Policies

At no cost paper copies of the Hospital Financial Assistance Application Form, Sliding Fee Application, a detailed Hospital Collection policy or the Hospital Financial Assistance Policy Summary may be obtained from the Business Office located at the main Hospital entrance or by calling 254-729-3281. Our Applications are available in English or Spanish and we do have other language assistance resources upon request. Click HERE for a printable Sliding Fee Application form, Policy and/or sliding Fee schedule. You will be able to see an example of the federal poverty guidelines by clicking on the link http://aspe.hhs.gov/poverty/.

Questions and Assistance in Completion of the Financial Assistance Application Form

For further questions or assistance in completion of the assistance application, please call our Business Office at 254-729-3281. You may also request a summary or complete copy of our Financial Assistance Policy from any business office employee or by calling or requesting the policy in writing to:

Limestone Medical Center

Attn: Business Office

701 McClintic Dr

Groesbeck, Texas 76642