Summary of Financial Assistance Policy

Eastside Endoscopy Center has a commitment to and respect for each person’s dignity with a special concern for those who struggle with barriers to access healthcare services. Eastside Endoscopy Center has an equal commitment to manage its healthcare resources as a service to the entire community. In furtherance of these principles, Eastside Endoscopy Center provides financial assistance for certain individuals who receive emergency or other medically necessary care from Eastside Endoscopy Center. This summary provides a brief overview of Eastside Endoscopy Center’s Financial Assistance Policy.

Who Is Eligible?

You may be eligible for financial assistance. Financial assistance is generally determined by your total household income and family size as compared to the Federal Poverty Level. If your income is less than or equal to 250% of the Federal Poverty Level, you will receive a 100% charity care write-off on the portion of the charges for which you are responsible. If your income is above 250% of the Federal Poverty Level but does not exceed 400% of the Federal Poverty Level, you will receive an uninsured discount. Patients who are eligible for financial assistance will not be charged more for eligible care than the amounts generally billed to patients with insurance coverage.

What Services Are Covered?

The Financial Assistance Policy applies to emergency and other medically necessary care. These terms are defined in the Financial Assistance Policy.

How Can I Apply?

To apply for financial assistance, you typically will complete a written application and provide supporting documentation, as described in the Financial Assistance Policy and the Financial Assistance Policy application.

How Can I Get Help with an Application?

For help with a Financial Assistance Policy application, you may obtain information online at http://eastsideendoscopy.com/ or call Vicky or Michelle at 586-447-5119.

How Can I Get More Information?

Copies of the Financial Assistance Policy and Financial Assistance Policy application form are available at http://eastsideendoscopy.com/ or at the Main Registration desks at all Eastside Endoscopy Center locations. Free copies of the Financial Assistance Policy and Financial Assistance Policy application also can be obtained by mail by sending a written request to the address below.

Eastside Endoscopy Center Attn: Financial Counseling/FAP

28963 Little Mack, Suite 103

St. Clair Shores, MI 48081

 

What If I Am Not Eligible?

If you do not qualify for financial assistance under the Financial Assistance Policy, you will receive formal notification and directions on how to appeal the decision from the Eastside Endoscopy Center location where you received services and applied for financial assistance.

Translations of the Financial Assistance Policy, the Financial Assistance Policy application, and this plain language summary are available in the following languages in: Arabic and Spanish

Eastside Endoscopy Center also offers services to translate over 200 other languages upon special request

 

Click to download and print Financial Assistance Application.