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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 San Antonio 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 San Antonio 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 San Antonio. 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 San Antonio is provided below.

You may request from Encompass Health Rehabilitation Hospital of San Antonio 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

Adams

Chad

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Aguirre

Felix

Family Medicine

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Alves

Tahira

Nephrology

10010 Rogers Crossing

San Antonio

TX

78251

210.549.3524

Amiry

Neda

Nurse Practitioner

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Amlani

Shehzad

Podiatry

12042 Blanco Rd Ste 310

San Antonio

TX

78216

210.341.4183

Annapureddy

Chandra

Internal Medicine

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Ashby

Hunter

Physical Medicine Rehab

5900 Balcones Dr Ste 4000

Austin

TX

78731

949.910.3090

Atique

Rashid

Internal Medicine

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Aziz

Wesam

Internal Medicine

17806 W Interstate 10 Ste 300

San Antonio

TX

78257

210.202.0304

Badireddy

Madhu

Internal Medicine

2313 Lockhill Selma Rd Ste 621

San Antonio

TX

78230

210.847.1486

Bertagnolli

Reono

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Bobbala

Govardhan

Family Medicine

2315 Dunmore Hl

San Antonio

TX

78230

309.838.4426

Bosley

Veronica

Nurse Practitioner

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Brazell

Arlene

Nurse Practitioner

2701 Babcock Rd Ste A

San Antonio

TX

78229

210.614.3225

Bubb

Aaron

Nurse Practitioner

4085 De Zavala Rd

San Antonio

TX

78249

210.387.3570

Buchmeier

Courtney

Nurse Practitioner

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Burchill

Keith

Physical Medicine Rehab

9119 Cinnamon Hill

San Antonio

TX

78240

718.974.6537

Cabello-Canales

Maria

Family Medicine

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Calhoun

Wesley

Nephrology

7142 San Pedro #120

San Antonio

TX

78216

210.692.7228

Campos

Danny

Nurse Practitioner

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Cardona

Iliana

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Cavin

Lillian

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Chandrahasan

Gopinath

Internal Medicine

4085 De Zavala Rd

San Antonio

TX

78249

210.387.3570

Cherukuri

Raja

Family Medicine

22211 I10 W Ste 1206

San Antonio

TX

78257

210.972.8058

Devulapally

Pavan

Nephrology

215 N San Saba Ste 301

San Antonio

TX

78207

210.212.8622

Diaz Wong

Roque

Nephrology

4330 Medical Dr Ste 105

San Antonio

TX

78229

218.692.7228

Fernando

Chaminda

Internal Medicine

24406 Treaty Creek

San Antonio

TX

78255

204.498.7622

Fiazuddin

Faraz

Internal Medicine

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Fonteneaux

Nina

Nurse Practitioner

11212 State Hwy 151 Plaza II Ste 105

San Antonio

TX

78251

210.871.4701

Gandhi

Jeet

Nephrology

6700 Randolph Blvd Ste 102

Live Oak

TX

78233

Gedala

Murthy

Nephrology

2829 Babcock Rd Tower 1 Ste 626

San Antonio

TX

78229

210.876.3658

Gorzell

Daniella

Nurse Practitioner

22211 I10 W Ste 1206

San Antonio

TX

78257

210.972.8058

Goyal

Abhijeet

Nephrology

8115 Data Point Dr Ste 200

San Antonio

TX

78229

210.614.7900

Guerra

Antonio

Family Medicine

16620 US Hwy 281 N Ste 300

San Antonio

TX

78232

210.403.5982

Herzik

Michael

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Hill

Barry

Physical Medicine Rehab

2 Spurs Lane Bldg 6 Ste 101

San Antonio

TX

78240

210.615.2225

Hoine

Haskel

Psychology/Neuropsychology

9119 Cinnamon Hill

San Antonio

TX

78240

210.558.9888

Iglehart

Elena

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Isbell

Melissa

Nephrology

16620 US Hwy 281 N Ste 300

San Antonio

TX

78232

210.614.1231

Jimenez

Santiago

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Johnson

Tiffany

Nurse Practitioner

22211 I10 W Ste 1206

San Antonio

TX

78257

210.972.8058

Jowlaei

Sousan

Nurse Practitioner

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Kamp

Maribel

Nurse Practitioner - Consulting

215 N San Saba Ste 301

San Antonio

TX

78207

210.212.8622

Karcher

Kelly

Nurse Practitioner

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Khan

Mehmood

Internal Medicine

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Kohli

Parmish

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Kuehn

Nicolaus

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Lampropoulos

Constantina

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Lopez

Arturo

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Luna

Maria

Nephrology

4330 Medical Dr Ste 105

San Antonio

TX

78229

218.692.7228

Maldonado

Jorge

Psychiatry

1634 Lockhill Selma

San Antonio

TX

78213

210.541.8455 x111

Malik

Aamir

Pulmonology

730 N Main Ste 321

San Antonio

TX

78205

210.228.9481

Manocha

Jahnavi

Physical Medicine Rehab

2701 Babcock Rd Ste A

San Antonio

TX

78229

210.614.3225

Martinez

Elaina

Nurse Practitioner - Wound Care

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Mehta

Praful

Internal Medicine

12318 Autumn Vista

San Antonio

TX

78249

210.523.9800

Meyermann

Mark

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Mir

Yasser

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Mogarala

Indraneel

Nephrology

8115 Data Point Dr Ste 200

San Antonio

TX

78229

210.614.7900

Mudipalli

Vasudeva

Family Medicine

11212 State Hwy 151

San Antonio

TX

78251

830.542.8566

Mushtaq

Uzair

Internal Medicine

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Naqvi

Syed

Internal Medicine

16620 US Hwy 281 N Ste 300

San Antonio

TX

78232

210.403.5982

Narayan

Rajeev

Nephrology

7142 San Pedro #120

San Antonio

TX

78216

210.403.0765

Narvaez

Marisa

Nurse Practitioner - Consulting

215 N San Saba Ste 301

San Antonio

TX

78207

210.212.8622

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

Orth

Gregory

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Patel

Neil

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Patel

Pratul

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Phillips

Amy

Nurse Practitioner - Consulting

4330 Medical Dr Ste 105

San Antonio

TX

78229

218.692.7228

Pierce

Jessica

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Ramanujam

Crystal

Podiatry

1303 McCullough Ste 348

San Antonio

TX

78212

210.227.4164

Ramos

Jose

Nurse Practitioner

17503 La Cantera Pkwy Ste 104-404

San Antonio

TX

78257

210.802.1661

Rana

Chaula

Physical Medicine Rehab

2701 Babcock Rd Ste A

San Antonio

TX

78229

210.614.3225

Randhawa

Jeewanjot

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Reyes

Homer

Family Medicine

7940 Floyd Curl Dr Ste 100

San Antonio

TX

78229

210.297.5520

Rosner

Howard

TeleCardiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Sanka

Shankar

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Sarao

Ravjot

Family Medicine

17806 W Interstate 10 Ste 300

San Antonio

TX

78257

210.202.0304

Schlegel

Kevin

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Sharma

Shirin

Nephrology

215 N San Saba Ste 301

San Antonio

TX

78207

210.212.8622

Sheplan

Bruce

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Sinha

Bishal

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Skinner

Barton

Nurse Practitioner

4085 De Zavala Rd

San Antonio

TX

78249

210.387.3570

Srinivasan

Venkat

Internal Medicine

19115 FM 2252 Ste 7

Garden Ridge

TX

78266

210.233.9440

Taliaferro

Zachary

Nurse Practitioner

23119 IH 10 W Ste 904

San Antonio

TX

78257

210.942.7680

Tarbox

Lauren

Nephrology

215 N San Saba Ste 301

San Antonio

TX

78207

210.212.8622

Thomas

Aaron

Internal Medicine

12446 W Ave Ste 200

San Antonio

TX

78216

210.525.1668

Thompson

Robert

Wound Care

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Umer

Syed

Cardiology

10010 Rogers Crossing

San Antonio

TX

83814

210.681.6176

Uy

Jimmy

Pulmonology

8019 S New Braunfels Ste 116

San Antonio

TX

78235

210.359.9898

Van Winkle

Ginger

Physician Assistant

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Vargas

Alberto

Family Medicine

16620 San Pedro Ave Ste 300

San Antonio

TX

78232

210.403.5982

Vasquez

Karina

Nephrology

10010 Rogers Crossing

San Antonio

TX

78251

210.549.3524

Velez

Jose

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Villarreal

Victor

Nephrology

16620 San Pedro Ave

San Antonio

TX

78232

210.614.1231

Watson

Chie

Nurse Practitioner

4085 De Zavala Rd

San Antonio

TX

78249

210.387.3570

Weikle

Geoff

Internal Medicine

12446 West Ave #200

San Antonio

TX

78216

210.525.1668

Willoughby

Samantha

Nurse Practitioner - Wound Care

5224 75th St Ste D

Lubbock

TX

79424

806.712.1096

Wong

Adrian

Nephrology

4458 Medical Dr Ste 205

San Antonio

TX

78229

210.614.1515

Yadao Gorospe

Edralin

Nurse Practitioner

16620 US Hwy 281 N Ste 300

San Antonio

TX

78232

210.403.5982

Attachment B – 2023 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 $14,580 $0 - $29,160 $29,161 - $43,740 $43,741 - $58,320
2 $19,720 $0 - $39,440 $39,441 - $59,160 $59,161 - $78,880
3 $24,860 $0 - $49,720 $49,721 - $74,580 $74,581 - $99,440
4 $30,000 $0 - $60,000 $60,001 - $90,000 $90,001 - $120,000
5 $35,140 $0 - $70,280 $70,281 - $105,420 $105,421 - $140,560
6 $40,280 $0 - $80,560 $80,561 - $120,840 $120,841 - $161,120
7 $45,420 $0 - $90,840 $90,841 - $136,260 $136,261 - $181,680
8 $50,560 $0 - $101,120 $101,121 - $151,680 $151,681 - $202,240

* For family units with more than 8 persons, add $5,140 for each additional person.