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Pricing Estimates and Information - Uninsured Patients

Patient Benefit Advisors

Patient Benefit Advisors are available to evaluate your eligibility for various Local and State Programs, including County Assistance and Medicaid. 888-253-1108

Charity Discount Policy

Good Samaritan Hospital has a Financial Assistance Policy that provides free hospital care for patients who have received non-elective care, do not meet the qualifications for Medicaid and whose income is less than 200% (in most cases) of the Federal Poverty Level. In order to qualify for this free care, you must complete a Financial Assistance Application and provide some documents to support your income. For patients with balances greater than $1,500, and whose documented income is between 201 and 400 % of the Federal Poverty Level, we have an expanded charity policy that may reduce the amount you owe. Access our full Financial Assistance Policy.

Uninsured Discount Policy

All Self-Pay patients, excluding elective cosmetic procedures and facility designated self-pay flat rate procedures, will be given an Uninsured Discount. Access our full Uninsured Discount Policy.

Payment

Similar to your visits to your physician's office, we request payment at the time of service or when you pre-register. If you are ineligible for Medicaid or Financial Assistance and cannot pay your entire estimated bill, we will work with you to set up payment arrangements. If, after your services are received, any additional payment is due, we will send you information about any amount you may still owe. We accept all major forms of payment.

Prior To Your Call

Before calling, please contact your physician's office to get the specific diagnosis or procedure description.

When you call our Service Center, please have the following information available, so that we can provide you with the most accurate estimate possible:

Description of services needed - we will need to know as much information as possible about the specific services as described by your physician.
Type of Services needed - we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.
Physician/Specialist Name - for example, if you are having surgery, we will want to know the surgeon's name.

What is not included in our estimates?

The estimates provided are only related to your hospital bill. Your personal physician or other physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists, and radiologists.

Independent laboratory and radiology services will also bill you separately for reading and interpreting EKGs, X-rays, EEGs and lab work. If you have questions about those bills, please call the number printed on their statements.

PreRegistration

When you have made an informed decision and are ready to proceed with services at our facility, you should contact your physician's office to ask to have your service scheduled.

Pre-registration is available to all scheduled patients prior to the date of service and expedites the admission process. All registration information will be obtained over the telephone.

When you arrive at the facility, you will be required to provide your identification, finalize financial arrangements and sign a few forms before going to the department.