Skip to main content

Financial assistance

We are committed to providing high quality rehabilitation care and services to our patients. Our hospital provides free or discounted emergency and other medically necessary care to patients who are uninsured or underinsured and who qualify for assistance under its Financial Assistance Policy. Learn about our financial assistance policy and how to apply for assistance.

Financial assistance policy

Purpose

 This policy outlines the circumstances under which the hospital will provide free or discounted emergency or other medically necessary care to eligible patients who are unable to pay for their care, as determined by the hospital in accordance with the eligibility criteria and other terms specified in this policy. Patients are expected to cooperate with the hospital’s procedures for obtaining Financial Assistance, securing insurance or other forms of payment, and contributing to the cost of their care based on their ability to pay.

This policy applies to emergency or medically necessary care provided by the hospital. This policy does not apply to care delivered by physicians or other healthcare providers who bill “privately” (separate from the hospital). (See Attachment A for additional information about physicians and other healthcare providers providing care within the hospital.)

This policy does not apply to care that is not emergency or medically necessary care, including elective services or items that are solely for the comfort or convenience of a patient.

Financial Assistance does not apply to amounts that are covered by insurance, governmental programs or other funding sources (which may include, but are not limited to, workers’ compensation, automobile or other liability insurance, crime victims’ compensation funds, and litigation recoveries). To be eligible for Financial Assistance, a patient is expected to apply for and comply with all processes related to seeking assistance from other insurers and/or third-party sources of payment (including all applicable governmental programs) as requested by hospital staff. Patients who are noncompliant or uncooperative in attempting to obtain insurance coverage, qualification under governmental programs, or payment from third-party sources will not be eligible for Financial Assistance.

A patient will be ineligible for Financial Assistance if the patient, or his or her representative, provides false information or falsified documentation of household size, income, assets, or other pertinent information.

Definitions

 Covered Services – emergency or medically necessary care provided by the hospital. Covered Services do not include services that are not emergency or medically necessary care, or care that is provided by physicians or other healthcare providers who bill “privately.”

Emergency or medically necessary care – services that are necessary and appropriate to sustain life or to prevent serious deterioration in the health of the patient from injury or disease. Medically necessary will be determined by the treating physician.

Family – includes spouse/domestic partner, children, and any other persons treated as “dependents” for federal income tax purposes.

Financial Assistance – reduction of an eligible patient’s account balance for Covered Services under the terms of this policy.

Patient – the individual receiving medical treatment and/or, in the case of an unemancipated minor or other dependent, the parent, legal guardian or other person (guarantor) who is financially responsible for the patient.

Uninsured – a patient who does not have health insurance coverage, is unable to obtain affordable coverage, and is ineligible for government healthcare programs or other third-party payment sources.

Underinsured – a patient who is not uninsured, but whose out-of-pocket medical expenses exceed his or her financial ability to pay.

Policy

Subject to the terms of this policy, Financial Assistance is provided to eligible patients who are uninsured or underinsured.

Eligibility for Financial Assistance, and the amount of Financial Assistance that will be provided, are based on an individualized assessment by the hospital of a patient’s financial need, generally determined by measuring the patient’s gross family income against the Federal Poverty Guidelines as specified in the Financial Assistance Discount Guidelines in Attachment B, provided that the patient does not have other financial resources that could be used to pay for his or her care. The Financial Assistance Discount Guidelines are adjusted annually to reflect changes in the Federal Poverty Guidelines.

Patients are presumed to be eligible for financial assistance, without completing an application, in the following circumstances:

  • Homelessness
  • Deceased with no estate
  • Mental incapacitation with no one to act on patient’s behalf
  • Recent Medicaid coverage, i.e. coverage within three (3) months of admission or discharge.

Presumptive financial assistance will be the most generous assistance available under the Financial Assistance Policy.

A patient determined to be eligible for Financial Assistance will not be billed more than the amount generally billed for emergency or other medically necessary care by hospital to individuals who have insurance covering such care. (See Attachment B for additional information about the “amount generally billed” limitation.)

If a patient is underinsured and is determined to be eligible for Financial Assistance, discounts will only apply to the balance due from the patient after insurance payments and other third-party payment sources have been applied to the account.

For purposes of this policy, “income” includes, but is not limited to, revenue from the following sources (before taxes):

  • Wages
  • Tips
  • Payments from Social Security
  • Retirement benefit payments
  • Unemployment compensation
  • Worker’s compensation
  • Veterans’ benefits
  • Public assistance
  • Alimony
  • Child support
  • Pensions
  • Regular insurance or annuity payments

Investment income

For purposes of this policy, “other financial resources” includes, but is not limited to the following:

  • Savings
  • Checking account
  • Medical savings account, healthcare savings account and/or flexible spending account
  • Trust fund
  • Retirement accounts
  • Investment assets
  • Other liquid assets
  • Equity value of real estate, other than the patient’s primary residence
  • Benefits from charity organizations
  • Pending litigation

To apply for Financial Assistance, a complete Financial Assistance Application is required. A complete Financial Assistance Application is inclusive of, but not limited to, disclosure of household size, employment information, income, assets and other financial resources, outstanding financial obligations, and supporting documents (such as recent tax returns, bank statements and pay stubs), as detailed in the Financial Assistance Application and the associated instructions.  If documentation proving household income is not available, patients may call the hospital finance department at the phone number listed above to discuss other evidence demonstrating eligibility. Undocumented residents (non-U.S. citizens living as residents in the U.S.) and patients who are without a home address may apply for Financial Assistance. Failure to provide the required information and documentation in a timely manner may result in ineligibility for Financial Assistance.

Complete Financial Assistance Applications should be submitted to the hospital at the address listed above. A hospital finance representative will review the application for completeness. Financial Assistance determinations must be approved by the Facility Controller, and in certain circumstances, by the hospital CEO. The hospital will notify patients in writing of the decision on their eligibility under this policy.

Copies of this policy, a plain language summary of this policy, the Financial Assistance Application, and the associated instructions are available free of charge upon request by writing to the address above. These documents can be found in the admitting/registration areas of the hospital and may also be downloaded at hospital’s website.

All patients will be offered a plain language summary of the Financial Assistance Policy during discharge or intake.

Billing statements will contain a written conspicuous notice informing patients about the availability of financial assistance, a telephone number where they may receive more information, as well as website address where the Financial Assistance Policy, application and plain language summary may be found.

Further information about this Financial Assistance Policy and assistance with the application process are available by calling Hospital Phone Number, or in person during normal business hours or by appointment from a hospital finance representative.

When a patient does not qualify for Financial Assistance under this policy but has special circumstances, other discounts may be available that are not part of this Financial Assistance Policy.  In these situations, hospital staff will review all available information (including documentation of income, liquid and illiquid assets, and other resources, amount of outstanding medical bills and other financial obligations) and make a case-by-case determination of the patient’s eligibility for other potential discounts.

Once a patient has been discharged and the patient’s balance due has been determined, the Billing Office will mail the patient monthly account statements and make phone calls in an attempt to collect the outstanding balance. If no payment has been received for 120 days, the account may be sent to a third-party collection agency.

The hospital, and any third parties acting on its behalf, do not engage in extraordinary collection actions such as lawsuits, liens, foreclosures, wage garnishment or reporting adverse information to credit agencies.

For additional information, please see the Billing and Collections Policy, which may be downloaded from hospital website. Copies are also available upon request, free of charge, by mail and in admitting/registration areas of the Hospital.

Nondiscrimination & emergency medical care

 Hospital does not have a dedicated emergency department. The hospital will appraise emergencies, provide initial treatment, and refer or transfer an individual to another hospital/facility, when appropriate, without discrimination and without regard to whether the individual is eligible for Financial Assistance.

Hospital will not engage in actions that discourage individuals from seeking emergency medical care, such as demanding that an individual pay before receiving initial treatment for emergency medical conditions or permitting debt collection activities that interfere with hospital’s appraisal and provision, without discrimination, of such initial treatment.

Billing and collections

Amounts charged to a patient eligible for Financial Assistance under this policy will be based on the applicable discount stated in the table above multiplied by the gross charges otherwise billable to the patient, subject to the “AGB” limitation described below.

In accordance with Internal Revenue Code section 501(r), a patient eligible for Financial Assistance under this policy will not be charged more than the amount generally billed to individuals who have insurance covering such care (“AGB”).

Facility has initially elected to calculate AGB under the “prospective Medicare method” described in applicable Treasury Regulations, using the billing and coding process the Facility would use if the individual were a Medicare fee-for-service beneficiary and setting AGB for the care at the amount the Facility determines would be the total amount Medicare would allow for the care (including both the amounts that would be reimbursed by Medicare and the amount the beneficiary would be personally responsible for paying in the form of co-payments, co-insurance, and deductibles).

Financial assistance policy - Plain language summary

Our hospital provides free or discounted emergency and other medically necessary care to patients who are uninsured or underinsured and who qualify for assistance under its Financial Assistance Policy. Assistance does not apply to elective services or items that are solely for the comfort or convenience of a patient. This document is only a summary. Please refer to the Financial Assistance Policy for complete details.

Eligibility Requirements and Assistance Offered Under the Financial Assistance Policy

Patients who qualify for assistance are eligible for income/asset-based, sliding scale discounts for emergency and other medically necessary care. In general:

Patients whose family income is equal to or less than 200% of the Federal Poverty Guidelines are generally eligible for free emergency and medically necessary care. 
Patients whose family income is between 200% and 400% of the Federal Poverty Guidelines are generally eligible for a sliding scale discount ranging from 50% to 75% for emergency and other medically necessary care.

A patient who qualifies for assistance under the Financial Assistance Policy will not be charged more for emergency or medically necessary care than amounts generally billed to patients having insurance covering such care.

How to Obtain Copies of the Financial Assistance Policy and Financial Assistance Application

Copies of the Financial Assistance Policy, this plain language summary, and the Financial Assistance Application and associated instructions are available free of charge upon request by writing to the address above. Copies can also be found in the admitting/registration areas of the hospital. These documents may be found online at the website provided above. Translations of these documents to Spanish are available upon request from our hospital and also may be found online at website address above.  

How to Apply for Assistance Under the Financial Assistance Policy

To apply for financial assistance, please submit a complete Financial Assistance Application with supporting documents to the address above.

Further information about the Financial Assistance Policy and assistance with the application process are available from the hospital controller via phone number listed above or in person at the address above.

Instructions - financial assistance application

Section A – patient and guarantor information

Patient Name: Clearly print on the blank line the first name, middle initial, and last name of the patient.
Date: Clearly print on the blank line the date of the application.
Guarantor: Clearly print on the blank line the first name, middle initial, and last name of the patient’s parent, legal guardian or other responsible person (“guarantor”).
Relationship: Clearly print on the blank line the relationship to the patient of the guarantor.
Address: Clearly print on the blank line the address where the patient lives including the city, state and zip.
Phone: Clearly print on the blank line the patient’s phone number.
Patient’s Employer: Clearly print on the blank line the name of the company for which the patient works.
Title: Clearly print on the blank line the job title of the patient.
Years Employed: Clearly print on the blank line the start date of employment.
Spouse’s Name: Clearly print on the blank line the first name, middle initial, and last name of the patient/guarantor’s spouse.
Spouse’s Phone: Clearly print on the blank line the patient’s phone number.
Spouse’s Employer: Clearly print on the blank line the name of the company for which your spouse works.
Title: Clearly print on the blank line the job title of your spouse.
Years Employed: Clearly print on the blank line the start date of employment of your spouse.
Length of Time at Current Residence: Clearly print on the blank line the dates you have lived at the address provided on the application.
Total number of Dependents: Clearly print on the blank line the number of dependents in your household, including yourself. Dependents are those that generally qualify as your dependent for federal income tax purposes.
Health Insurance Provider: Clearly print on the blank line the name of your health insurance carrier (including Medicare, Medicaid or other governmental coverage you may have).
Policy number: Clearly print on the blank line the policy or account number of your insurance policy.

Section B – assets

Total Household Income: Clearly print the assets of your household (yourself, your spouse, and dependents). You may attach additional sheets of paper if more space is needed. Provide the cash value as well as any loans or obligations you have on that asset

If your household has assets that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
Assets include, but are not limited to savings and checking accounts, medical savings accounts, healthcare savings accounts, flexible spending accounts, trusts, retirement accounts, investment assets, other liquid assets, real estate (other than primary residence), benefits from charity organizations, pending or finalized litigation settlements, etc.
Years Employed: Clearly print on the blank line the start date of employment.
Spouse’s Name: Clearly print on the blank line the first name, middle initial, and last name of the patient/guarantor’s spouse.
Spouse’s Phone: Clearly print on the blank line the patient’s phone number.
Spouse’s Employer: Clearly print on the blank line the name of the company for which your spouse works.
Title: Clearly print on the blank line the job title of your spouse.
Years Employed: Clearly print on the blank line the start date of employment of your spouse.
Length of Time at Current Residence: Clearly print on the blank line the dates you have lived at the address provided on the application.
Total number of Dependents: Clearly print on the blank line the number of dependents in your household, including yourself. Dependents are those that generally qualify as your dependent for federal income tax purposes.
Health Insurance Provider: Clearly print on the blank line the name of your health insurance carrier (including Medicare, Medicaid or other governmental coverage you may have).
Policy number: Clearly print on the blank line the policy or account number of your insurance policy.

Section C – income
Total Household Income: Clearly print the income your household (yourself, your spouse, and dependents) receives from all sources. You may attach additional sheets of paper if more space is needed. Provide the gross amounts and the amounts received after taxes and other deductions.

If your household receives income from a source that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
Sources of income include, but are not limited to wages, tips, social security payments, retirement benefits, unemployment, workers’ compensation, veteran benefits, public assistance, alimony, child support, pensions, insurance or annuity contracts, investment income, etc.

Section D – debts and obligations

Total Household Debts and Obligations: Clearly print the debts and obligations of your household (yourself, your spouse, and dependents). You may attach additional sheets of paper if more space is needed. Provide the total amount of the liability and the monthly payment amounts.

If your household has debts or obligations that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
If your household has debts or obligations that are not paid by you every month, take the total amount due during the past 12 months, divide it by 12, and then indicate that amount on the application.
Sources of debts and obligations include, but are not limited to real estate mortgages, household utility bills, telephone, food, automobile loans, charge and credit accounts, other loans, etc.

Section E – required documentation

The documents listed in this section are needed to help us determine if you qualify for financial assistance under our Financial Assistance Policy. If you do not have, or cannot produce the items listed, please include an explanation as to why. Please note that additional information or documentation may be requested by a Hospital representative when processing your application.

Section F – Certification

Patient/Guarantor’s Signature: Carefully read the acknowledgement statement in this section and then sign and date the application.

Mailing Instructions/Contact Information

Submit the completed Financial Assistance Application along with supporting documentation to the hospital’s address.

Further information about the Financial Assistance Policy or assistance with the application process are available from the hospital controller via the hospital phone number, in person at the hospital address or online at the website address. Certain foreign language translations of the Financial Assistance Policy, Plain Language Summary, Financial Assistance Application and Instructions are available upon request.

Provider/physician listing

Services may be provided in Encompass Health Rehabilitation Hospital of Austin by the hospital as well as by other health care practitioners, who may or may not participate with the same health insurers or health maintenance organizations (HMOs) as Encompass Health Rehabilitation Hospital of Austin and who may bill you separately. These providers are encouraged, but not required, to follow the financial assistance policy of Encompass Health Rehabilitation Hospital of Austin. You should contact the health care practitioner who will provide services to you to determine which health insurers and HMOs the practitioner participates in as a network provider or preferred provider. Contact information for practitioners who may provide services to you during your stay at Encompass Health Rehabilitation Hospital of Austin is provided below.

You may request from Encompass Health Rehabilitation Hospital of Austin and other health care providers a personalized estimate of reasonably anticipated charges for the treatment of your specific condition.

This listing is updated quarterly and additional providers or physicians may be added and/or presented under an alternate name that may be different from what is listed below. Please call us directly so that we can assist you with the most current and accurate information.

 

Last Name
First Name
Specialty
Address
City
St
ZIP
Phone

Abburi

Madhava

Internal Medicine

7000 N Mopac Expy Ste 420

Austin

TX

78731

512.827.2947

Aghera

Amita

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Ali

Zarintaj

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Alpar

Andrew

Nephrology

901 S Mopac Expressway Bldg 1 Ste 300

Austin

TX

78746

512.735.3013

Antony

Anu

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Arizmendez

Maria Elena

Physical Medicine Rehab

PO Box 163895

Austin

TX

78716

512.401.3165

Arthur

Albert

Family Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Babila Tita

Vanatius

Podiatry

5625 Elger Rd Ste 110

Austin

TX

78735

512.447.4122

Baricuatro

Marica

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Baru

Ashvin

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Basu

Nabanita

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Bernardin

Guerin

Psychology/Neuropsychology

11211 Taylor Draper Ln Ste 202

Austin

TX

78759

512.897.8879

Berneburg

Kurt

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Berry

Stephen

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Bertagnolli

Reono

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Betts

Judith

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Bimali

Yagya

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Blackburn

Mary

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Bogar

Mark

Physical Medicine Rehab

330 W Ben White Blvd

Austin

TX

78704

512.363.5779

Boldt

Brian

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Boline

Emilie

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Bowker

Angela

Nurse Practitioner

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Capello

Jeremy

Psychology/Neuropsychology

11211 Taylor Draper Ln Ste 202

Austin

TX

78759

512.897.8879

Chow

Frank

Internal Medicine

7000 N Mopac Expy Ste 420

Austin

TX

78731

512.827.2947

Cipleu

Cristian

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Clitheroe

Scott

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Cowper

Pamela

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Crispell

Carolyn

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Dao

Kim

Podiatry

5625 Elger Rd Ste 110

Austin

TX

78735

512.447.4122

Doan

Ellis

Internal Medicine

7000 N Mopac Expy Ste 420

Austin

TX

78731

512.827.2947

Duke

Marc

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

El Khoury

Raymonda

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Emery

Michael

Nurse Practitioner

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Erko

Amsalu

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Falvey

Thomas

Modified Barium Swallows

1717 Rotary Dr

Humble

TX

77338

281.272.6277

Fierro

Lisa

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Galvan

Ted

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Gamboa

Antonio

Internal Medicine

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Garcia

Pete

Internal Medicine

1822 W Braker Ln Suite 81603

Austin

TX

78758

512.477.4882

George

Aneesh

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Gil

Janelle

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Ginn

Stacy

Nurse Practitioner

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Gitterle

Marcus

Wound Care

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Goble

Cara

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Goss

Harry

Nephrology

1720 East Whitestone Blvd Ste A

Cedar Park

TX

78613

512.451.5800

Gowda

Suma

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Grant-Jennings

Grace

Internal Medicine

7000 N Mopac Expy Ste 420

Austin

TX

78731

512.827.2947

Gray

Laura

Physical Medicine Rehab

330 W Ben White Blvd

Austin

TX

78704

512.730.4800

Guzman-Limon

Monica

Nephrology

3000 North IH 35 Ste 635

Austin

TX

78705

512.320.1500

Hines

Peter

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Hines

Timothy

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Hoke

Cassandra

Psychology/Neuropsychology

11211 Taylor Draper Ln Ste 202

Austin

TX

78759

512.897.8879

Hollifield

Cassandra

Physician Assistant

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Holub

Kate

Nurse Practitioner

321 W Ben White Blvd Ste 200

Austin

TX

78704

512.451.5800

Huang

Benjamin

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Hudson

Rosalie

Internal Medicine

4107 Medical Pkwy Ste 200

Austin

TX

78756

512.799.5518

Jackson

Philip

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Jackson

Emily

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Jacobson

Tatiana

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Jimenez

Santiago

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Jones

David

Nurse Practitioner

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Joseph

Berril

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Joseph

Sindhu

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Kalyanaswamy

Narmadha

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Karka

Lindsey

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Karunakaran

Deepa

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Koestel

Christine

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Korban

Elyssa

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Kunnappillil

Teena

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Lim

Tobin

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Lu

Ting-Chi

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Malik

Sofia

Nurse Practitioner

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Mami

Camille

Psychology/Neuropsychology

11211 Taylor Draper Ln Ste 202

Austin

TX

78759

512.897.8879

Manasa

Poonam

Physical Medicine Rehab

6913 Estana Ln

Austin

TX

78739

512.560.0522

Mann

Micah

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Marino

Sarah

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Marquardt

Stella

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Martin

Jason

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Martin

Sarah

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Martinez-Colon

Laura

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Mayes

Katherine

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Mehta

Rajesh

Gastroenterology

4007 James Casey Ste C210

Austin

TX

78745

512.368.5294

Meyermann

Mark

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Mididoddi

Ravi

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Miller

Peter

Nephrology

321 W Ben White Blvd Ste 200

Austin

TX

78704

512.451.5800

Moore

Walter

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Mosier

Andrew

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Nader

Paul

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Nasser

Yasser

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Newman

Jack

TeleCardiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Nguyen

David

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Nguyen

Vi

Podiatry

5625 Elger Rd Ste 110

Austin

TX

78735

512.447.4122

Novick

Tessa

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Ong

Jon-Michael

Physical Medicine Rehab

1317 Bonham Ter

Austin

TX

78704

210.802.5425

Patel

Pratul

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Pelphrey

Andrew

Nephrology

321 W Ben White Blvd Ste 200

Austin

TX

78704

512.451.5800

Phalen

Letitia

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Prokop-Fettig

Donna

Physician Assistant

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Ramdeen

Khris

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Richman

Jessica

Physician Assistant

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Robinson

Dennis

Podiatry

4131 Spicewood Springs Rd Ste L-3

Austin

TX

78759

512.930.3753

Rodriguez

William

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Rodriguez-Sanchez

Javier

Nephrology

1720 East Whitestone Blvd Ste A

Cedar Park

TX

78613

512.451.5800

Rosen

Mark

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Rosner

Howard

TeleCardiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Rowder

Nicholas

Nephrology

321 W Ben White Blvd Ste 200

Austin

TX

78704

512.451.5800

Saif

Maryam

Internal Medicine

7000 N Mopac Expy Ste 420

Austin

TX

78731

512.827.2947

Salazar

Abel

Modified Barium Swallows

1717 Rotary Dr

Humble

TX

77338

281.272.6277

Schnelle

Sarah

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Sclafani

Joseph

Internal Medicine

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Shah

Mala

Physician Assistant

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Siby

Jess

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Smiley

Sarah

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Somal

Loveleen

Internal Medicine

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Temple

Richard

Psychology/Neuropsychology

706 B West Ben White Blvd Ste 120B

Austin

TX

78737

512.294.2304

Thielke

Julie

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Tolan

Scott

Internal Medicine

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Uebbing

Nancy

Nurse Practitioner

408 W 45th St

Austin

TX

78751

512.451.5800

Varnum

Cindy

Nurse Practitioner

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Varshney

Deepa

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Vela

Octavio

Physical Medicine Rehab

4906 Strass

Austin

TX

78731

512.775.1040

Velji

Glenda

Nurse Practitioner

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Venkatesh

Sujatha

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Vinta

Malavika

Nephrology

408 W 45th St

Austin

TX

78751

512.451.5800

Vu-Wallace

Anna Ha-Linh

Internal Medicine

5656 Bee Caves Rd Bldg C Ste 101

Austin

TX

78756

512.323.5465

Wagner

Elliott

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Walker

Haley

Nurse Practitioner

575 Vendemmia Bend

Austin

TX

78738

512.840.1158

Ward

David

Nurse Practitioner

3901-A Spicewood Springs Ste 201

Austin

TX

78759

737.226.6700

Wiedower

Ronnie

Modified Barium Swallows

1717 Rotary Dr

Humble

TX

77338

281.272.6277

Attachment B – 2021 Financial Assistance Discount Guidelines

Amounts charged to a patient eligible for Financial Assistance under this policy will be based on the applicable discount stated in the table above multiplied by the gross charges otherwise billable to the patient, subject to the “AGB” limitation described below.

In accordance with Internal Revenue Code section 501(r), a patient eligible for Financial Assistance under this policy will not be charged more than the amount generally billed to individuals who have insurance covering such care (“AGB”).

Facility has initially elected to calculate AGB under the “prospective Medicare method” described in applicable Treasury Regulations, using the billing and coding process the Facility would use if the individual were a Medicare fee-for-service beneficiary and setting AGB for the care at the amount the Facility determines would be the total amount Medicare  would allow for the care (including both the amounts that would be reimbursed by Medicare and the amount the beneficiary would be personally responsible for paying in the form of co-payments, co-insurance, and deductibles).

Discount provided 100% discount 75% discount 50% discount
Family size Federal poverty guideline* Income less than or equal to 200% of FPG Income of 201%-300% of FPG Income of 301%-400% of FPG
1 $13,590 $0 - $27,180 $27,181 - $40,770 $40,771 - $54,360
2 $18,310 $0 - $36,620 $36,621 - $54,930 $54,931 - $73,240
3 $23,030 $0 - $46,060 $46,061 - $69,090 $69,091 - $92,120
4 $27,750 $0 - $55,500 $55,501 - $83,250 $83,251 - $111,000
5 $32,470 $0 - $64,940 $64,941 - $97,410 $97,411 - $129,880
6 $37,190 $0 - $74,380 $74,381 - $111,570 $111,571 - $148,760
7 $41,910 $0 - $83,820 $83,821 - $125,730 $125,731 - $167,640
8 $44,660 $0 - $93,620 $93,621 - $139,890 $139,891 - $186,520

* For family units with more than 8 persons, add $4,720 for each additional person.