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Financial Assistance Program - Plain Language Summary

John D. Archbold Memorial Hospital, Inc. ("Archbold") offers two Financial Assistance Programs for uninsured and indigent patients.  An uninsured patient is someone who has no health coverage at all, and who does not have any right to be reimbursed for healthcare expenses by someone else. A patient who has health coverage is considered uninsured if the patient has a claim denied based on a pre-existing condition, having reached benefit maximums, or that a particular service is not covered.  For purposes of financial assistance offered by Archbold, a person with an annual household income below 200% of the Federal Poverty Line is considered indigent, regardless of whether that person has healthcare coverage.

The purpose of this Plain Language Summary is to provide general information for the two Financial Assistance Programs offered by John D. Archbold Memorial Hospital.  Please refer to the complete policies entitled “Financial Assistance Program – Indigent Care Trust Fund” and “Financial Assistance Program – Uninsured Patients” for further details.

Click here for the complete Financial Assistance Program – Plain Language Summary Policy

Program #1: The Indigent Care Trust Fund (“ICTF”) Financial Assistance Program          

If you are indigent or uninsured with an annual household income of less than 200% of the Federal Poverty Level (please see box below), you will qualify for the ICTF Financial Assistance Program provided that you (1) are a resident of the State of Georgia; (2) complete the application for Financial Assistance; and (3) apply for Medicaid, Medicare or Medicare Disability, if requested.  If you are eligible for the ICTF Financial Assistance Program, you will receive a complete write-off of all charges for services.                      

Click here for the complete Financial Assistance Program – Indigent Care Trust Fund Policy

Click here for the Financial Assistance Program Application (PDF)

Click here for the Financial Assistance Program Application (Word Document)

You have a right to:

  • The availability of free and reduced-charge services
  • The ability to gain admittance without pre-admission deposits
  • Not be transferred solely or in significant part for economic reasons
  • The availability of services provided
  • The terms of eligibility for free and reduced services
  • The application process free and reduced charges
  • The person or office to which complaints or questions about the hospital’s participation in or operation of the program may be directed

Program #2: The Financial Assistance Program for Uninsured Patients

If you are an uninsured patient who lives in Brooks, Grady, Mitchell or Thomas County, Georgia, or in a county in Georgia that does not have a hospital offering the services you require, and your annual household income falls between 200% and 325% of the Federal Poverty Level (please see box below), you may be eligible for a discount for medical services. 

To be eligible, you must: (1) submit an application for assistance within 240 days from the date the patient account is billed; (2) apply for commercial or government insurance coverage if requested; (3) have personal and business assets, excluding your personal residence, totaling less than $50,000.00; and (4) comply with an interest-free payment plan following a determination of your qualification for assistance.

If you are found by Archbold to be qualified for assistance under the Financial Assistance Program for Uninsured Patients, you will be charged no more than "amounts generally billed," which is based on the average of the amounts actually paid to the hospital facility by private health insurers and Medicare, including co-payments and deductibles, for the medically necessary or emergency services that you receive. 

Click here for the complete Financial Assistance Program – Uninsured Patients Policy

Click here for the Financial Assistance Program Application (PDF)

Click here for the Financial Assistance Program Application (Word Document)

A free copy of Archbold's financial assistance policies and the application forms for financial assistance may be obtained by downloading them from Archbold's website (www.archbold.org).  Free copies are also available at each hospital facility in the admissions or registrations areas.  You may also call 229-228-8870, Account Management Services, to request that a free copy of the policies and application forms be mailed to you.           

Archbold staff located in the admissions and registration areas are available to provide information about the Financial Assistance Programs as well to help you complete the application process.  You may also reach the appropriate staff to obtain this information or assistance by calling 229-228-8870 or 229-228-8840.  

To help you determine which program to apply for we have provided the current poverty guidelines as determined by the Department of Health and Human Services:

 

2015 Federal Poverty Guidelines

 

Number of Persons in Household

Federal Poverty Income Guidelines

1

$11,700

2

$15,930

3

$20,090

4

$24,250

5

$28,410

6

$32,570

7

$36,730

8*

$40,890

*For families/household with more than 8 persons, add $4,160 for each additional person.

 

Help with your hospital bills:

In order to determine if you are eligible for financial help with your bills for inpatient and outpatient services, please complete our Financial Assistance Application.  For questions contact our Case Manager at 229-228-8840 or 1-877-269-8181, ext. 8840.  You may also FAX your questions to 229-228-8893.  Archbold Medical Center’s Patient Financial Services is located at 920 Cairo Rd., Thomasville, Georgia.

If you have problems:

If you have any concerns about how we operate programs under the Indigent Care Trust Fund rules, please let us try to work with you to resolve them.  You may reach Archbold Medical Center’s Patient Financial Services management at 229-228-8861.  Your call will be returned within three business days. However, if you are not satisfied with our handling of your situation, you may call the Department of Community Health toll-free at 1-877-261-3117 or write to:  

Indigent Care Trust Fund
Medical Policy Unit, Hospital Services
Division of Medicaid
2 Peachtree Street, NW, 37th Floor
Atlanta, GA 30303-3159

Archbold Memorial Hospital | (229) 228-2000
915 Gordon Ave, Thomasville, GA 31792

Brooks County Hospital | (229) 263-4171
903 North Court Street, Quitman, GA 31643
Grady General Hospital | (229) 377-1150
1155 5th St., Cairo, GA 39828

Mitchell County Hospital | (229) 336-5284
90 East Stephens St., Camilla, GA 31730
 

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