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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 Toms River 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 Toms River 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 Toms River. 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 Toms River is provided below.

You may request from Encompass Health Rehabilitation Hospital of Toms River 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

Aaron

Michael

Cardiology

1820 State Route 33 Ste 4B

Neptune

NJ

07753

732.776.8500

Adusumilli

Padmashree

Physical Medicine Rehab

14 Hospital Dr

Toms River

NJ

08755

732.505.5123

Agrawal

Apurv

Oncology Hematology

1608 Route 88 West Ste 250

Brick

NJ

08724

732.840.8880

Al Khaldi

Aous

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Albanese

Joseph

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Alcasid

Patrick

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Alcid

Jess

Orthopaedics

530 Lakehurst Rd Ste 101

Toms River

NJ

08755

732.349.8454

Allawi

Ali

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Anantharaman

Priya

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Anghel-Filip

Anemona

Cardiology

368 Lakehurst Rd Ste 301

Toms River

NJ

08755

732.240.1048

Araujo

Martin

Family Medicine

1255 Route 70 W Ste 12N

Lakewood

NJ

08701

732.942.0888

Baerga

Edgardo

Physical Medicine Rehab

2 Centre Plz

Tinton Falls

NJ

07724

732.460.5360

Bertagnolli

Reono

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Blakeslee

Christopher

Podiatry

100 W Veterans Hwy Ste 11

Jackson

NJ

08527

732.833.6888

Brackin

George

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Brackin

Phillip

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Brouder

Daniel

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Brunner

Brenden

Internal Medicine

PO box 1120

Toms River

NJ

08754

503.789.2990

Bruno

Robert

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Castillo

Mary Jane

Nurse Practitioner

508 Lakehurst Rd Ste 3A

Toms River

NJ

08755-8000

732.341.4600

Chamsuddin

Abbas

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Chu

Tony

Cardiology

1820 State Route 33 Ste 4B

Neptune

NJ

07753

732.776.8500

Chung

Margaret

Infectious Disease

1163 Route 37 W Ste D3

Toms River

NJ

08755

732.797.1979

Clark

Nancy

Podiatry

ø1163 Rte 37 West Ste B2

Toms River

NJ

08755

732.966.1285

Corpuz

Gabrielle

Physician Assistant

301 Lakehurst Rd

Toms River

NJ

08755

732.281.1590

Das

Saumya

Internal Medicine

495 Lakehurst Rd

Toms River

NJ

08755

732.473.0300

Dave

Bhavika

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Desai

Dilip

Internal Medicine

20 Hospital Dr Ste 19

Toms River

NJ

08755

732.341.8044

Dixon

Joseph

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Drake

Kevin

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Drakh

Alexander

Physical Medicine Rehab

14 Hospital Dr

Toms River

NJ

08755

732.279.7656

Ellis

Stephen

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Farmer

Rajesh

Podiatry

52 Berlin Rd Ste 5000

Cherry Hill

NJ

08034

856.795.1003

Ferencz

Gerald

Neurology

633 Route 37 West

Toms River

NJ

08755

732.240.0087

Gabudao

Anselma

Nurse Practitioner

25 Mule Rd Ste B8

Toms River

NJ

08755

732.240.4000

Gelormini

Russell

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Ghetiya

Savan

Internal Medicine

1749 Hooper Ave Suite 203

Tom Rivers

NJ

08753

732.864.7030

Ghetiya

Vinodrai

Internal Medicine

1749 Hooper Ave Suite 203

Tom Rivers

NJ

08753

732.864.7030

Girgis

Ihab

Cardiology

1820 State Route 33 Ste 4B

Neptune

NJ

07753

732.776.8500

Gordon

Jay

Psychology/Neuropsychology

388 Lakehurst Rd Ste 2A

Toms River

NJ

08755

732.930.2242

Guarino

Joseph

Cardiology

25 Mule Rd Ste B2

Toms River

NJ

08755

732.240.3700

Guerrero

Isabel

Infectious Disease

25 Mule Rd Ste B-1

Toms River

NJ

08755

732.286.2565

Gupta

Avinash

Cardiology

637 River Ave

Lakewood

NJ

08701

732.886.9101

Haider

Nadeem

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Hartwell

Richard

Neurosurgery

9 Hospital Drive Ste C10

Toms River

NJ

08755

732.341.1881

Holt

Matthew

Nurse Practitioner

508 Lakehurst Rd Ste 3A

Toms River

NJ

08755-8000

732.341.4600

Huttemann

Karen

Psychology/Neuropsychology

388 Lakehurst Rd Ste 2A

Toms River

NJ

08755

732.930.2242

Igidbashian

Vartan

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Iglesias

Jose

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Jain

Keshani

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Jain

Sanjay

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Jimenez

Santiago

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Johnson

Nancy

Psychology/Neuropsychology

388 Lakehurst Rd Ste 2A

Toms River

NJ

08755

732.930.2242

Kamel

Emad

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Kapoor

Rajat

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Karam

Edmund

Cardiology

1820 State Route 33 Ste 4B

Neptune

NJ

07753

732.776.8500

Kasper

Mark

Orthopaedics

530 Lakehurst Rd Ste 101

Toms River

NJ

08755

732.349.8454

Kelly

Shannon

Nurse Practitioner

601 Route 37 Ste 104

Toms River

NJ

08757

732.240.1100

Kerr

Brian

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Khan

Muhammad

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Krishna

Sunanda

Internal Medicine

3 Plaza Dr Ste 14

Toms River

NJ

08757

732.240.0303

Krishnan

Lalitha

Endocrinology

26 Bentley LN

Ocean Twp

NJ

07712

908.839.1554

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

Ledesma

Milagros

Nurse Practitioner

508 Lakehurst Rd Ste 3A

Toms River

NJ

08755-8000

732.341.4600

Lieberman

Jeffrey

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Liu

Jason

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Lokchander

Rangaswamy

Gastroenterology

301 Lakehurst Rd

Toms River

NJ

08755

732.281.1590

Londen

Elizabeth

Psychology/Neuropsychology

388 Lakehurst Rd Ste 2A

Toms River

NJ

08755

732.930.2242

Lopez

Susan

Nurse Practitioner

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Ly

Justin

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Lynch

Richard

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Markatos

Angelo

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Mathew

Tittymol

Internal Medicine

530 Lakehurst Road Ste 307

Toms River

NJ

08755

732.341.8901

Mathur

Anjana

Internal Medicine

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.8885

McDonald

Philip

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Mehta

Nikunj

Internal Medicine

9 Mule Rd Ste 14E

Toms River

NJ

08755

732.244.1080

Meyer

Ariel

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Meyermann

Mark

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Morelos

Joseph

Internal Medicine

1255 Route 70 W Ste 12N

Lakewood

NJ

08701

732.942.0888

Mupparaju

Jyothsna

Internal Medicine

413 Lakehurst Rd Ste 200

Toms River

NJ

08755

732.703.7940

Nag

Debashis

Physical Medicine Rehab

9 Hospital Dr Ste C25

Toms River

NJ

08755

732.736.0100

Nagaria

Neil

Gastroenterology

301 Lakehurst Rd

Toms River

NJ

08755

732.281.1590

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

Palecki

Winicjusz

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Panchani

Mrugesh

Nephrology

508 Lakehurst Rd Ste 3A

Toms River

NJ

08755-8000

732.341.4600

Pandya

Kiritkumar

Urology

9 Hospital Dr

Toms River

NJ

08755

732.364.2262

Parikh

Jayesh

Pulmonology

9 Hospital Drive Ste A-18

Toms River

NJ

08755

732.557.5515

Parikh

Sandip

Internal Medicine

35 Beaverson Blvd Ste 6B

Brick

NJ

08723

732.262.0222

Parikh

Vipul

Internal Medicine

601 Route 37 Ste 104

Toms River

NJ

08757

732.240.1100

Park

Jin

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Patel

Akshay

Internal Medicine

9 Hospital Dr Ste B1

Toms River

NJ

08755

732.363.7200

Patel

Amy

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Patel

Dakshesh

Neurology

20 Hospital Dr Ste 15

Toms River

NJ

08755

732.538.8100

Patel

Himanshu

Internal Medicine

9 Hospital Dr Ste C12

Toms River

NJ

08757

732.228.7407

Patel

Manoj

Internal Medicine

9 Hospital Dr Ste B1

Toms River

NJ

08755

732.363.7200

Patel

Palakkumar

Internal Medicine

662 Commons Way Bldg 14

Toms River

NJ

08755

732.279.3681

Patel

Sandip

Internal Medicine

9 Hospital Dr Ste B1

Toms River

NJ

08755

732.363.7200

Patel

Sizan

Internal Medicine

9 Hospital Dr Ste B1

Toms River

NJ

08755

732.363.7200

Pawa

Sakshi

Internal Medicine

9 Mule Rd Ste E13

Toms River

NJ

08753

732.349.8888

Pennington

Norman

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Pham

Justin

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Pinzon

Marvin

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Radhakrishnan

Jay

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Ramachandra Rao

Vanie

Internal Medicine

14 Hospital Dr

Toms River

NJ

08755

732.505.5028

Raval

Sumul

Neurology

100 State Hwy 36

West Long Branch

NJ

07764

732.229.6200

Reiff

Kaitlyn

Nurse Practitioner

100 State Hwy 36

West Long Branch

NJ

07764

732.229.6200

Rizzo

Nicole

Nurse Practitioner

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Robertson

Cassandra

Nurse Practitioner

601 Route 37 Ste 104

Toms River

NJ

08757

732.240.1100

Rosner

Howard

TeleCardiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Rozman

Anatoly

Physical Medicine Rehab

2 Centre Plaza

Tinton Falls

NJ

07724

732.460.5337

Rudorfer

Erik

Podiatry

788 Maple Ave

Brick

NJ

08724

908.692.7004

Saini

Manish

Internal Medicine

1163 Route 37 W Ste B1

Toms River

NJ

08755

732.341.7900

Sancheti

Vinod

Internal Medicine

25 Mule Rd Ste B8

Toms River

NJ

08755

732.240.4000

Sayne

Kimberly

Nurse Practitioner

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Schirripa

Joseph

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Shah

Ankit

Nephrology

210 Jack Martin Blvd Ste D-1

Brick

NJ

08724

732.458.5057

Shah

Bankim

Internal Medicine

25 Mule Rd Ste B4

Toms River

NJ

08755

732.341.0020

Shah

Dhiren

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

Shah

Sweta

Family Medicine

25 Mule Rd Ste B4

Toms River

NJ

08755

732.341.0020

Shamash

Felix

Vascular Surgery

26 Pine Blvd

Lakewood

NJ

08701

732.364.1010

Sharma

Anil

Internal Medicine

3 Plaza Dr Ste 4

Toms River

NJ

08757

732.473.0025

Sheth

MeetKumar

Internal Medicine

1255 Route 70 W Ste 12N

Lakewood

NJ

08701

732.942.0888

Sikand

Sanjay

Internal Medicine

214 Jack Martin Blvd Ste 2

Brick

NJ

08724

732.903.7863

Sikand

Vinay

Pulmonology

508 Lakehurst Road Ste 1A

Toms River

NJ

08755

732.244.5864

Sobti

Rimmi

Internal Medicine

511 Lakehurst Rd

Toms River

NJ

08755

732.797.0007

Sonatore

Carol

Physical Medicine Rehab

129 North County Line Rd Ste 314

Jackson

NJ

08527

732.579.8303

Strazzella

William

Pulmonology

20 Hospital Dr Ste 17B

Toms River

NJ

08755

732.557.6030

Taguiam

Dirksen

Nurse Practitioner

508 Lakehurst Rd Ste 3A

Toms River

NJ

08755-8000

732.341.4600

Takahashi

Guy

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Talamati

Jayanthi

Internal Medicine

3 Plaza Dr Ste 14

Toms River

NJ

08757

732.240.0303

Talamayan

Randy

Internal Medicine

1255 Route 70 W Ste 12N

Lakewood

NJ

08701

732.942.0888

Toma

Katherine

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Toor

Saddad

TeleCardiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Tranchini

Laura

Physician Assistant

301 Lakehurst Rd

Toms River

NJ

08755

732.281.1590

Utpat

Sandeepa

Infectious Disease

9 Hospital Dr Ste B4

Toms River

NJ

08755

732.905.6635

Uzun

Nagehan

Physical Medicine Rehab

64 Cranbury Neck Rd

Cranbury

NJ

08512

732.763.5138

Vierbuchen

Clare

Psychology/Neuropsychology

388 Lakehurst Rd Ste 2A

Toms River

NJ

08755

732.930.2242

Wagner

Lloyd

TeleRadiology

6548 Comanche Trail Ste 501

Austin

TX

78732

866.218.3754 x3005

Weiner

Leonard

Nephrology

1541 Route 88 Ste A

Brick

NJ

08724

732.836.3200

Woodruff

Charles

TeleRadiology - Rely Radiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Wu

Chi

Physical Medicine Rehab

1035 Hooper Ave Ste 2D

Toms River

NJ

08753

732.505.5050

Wynkoop

Walter

Pulmonology

20 Hospital Dr Ste 9

Toms River

NJ

08755

732.341.1380

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.