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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 an income/asset-based discount for emergency and other medically necessary care. In general:
Patients whose family income is equal to or less than 300% of the Federal Poverty Guidelines are generally eligible for free emergency and 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.  
 
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.
 
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.  

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 Geisinger Encompass Health Rehabilitation Hospital 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 Geisinger Encompass Health Rehabilitation Hospital and who may bill you separately.  These providers are encouraged, but not required, to follow the financial assistance policy of Geisinger Encompass Health Rehabilitation Hospital  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 Geisinger Encompass Health Rehabilitation Hospital is provided below.

You may request from Geisinger Encompass Health Rehabilitation Hospital 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 at 570.271.6110 and ask to speak with Credentialing, so that we can assist you with the most current and accurate information.

Last Name
First Name
Specialty
Address
City
St
ZIP
Phone

Ahn

Chulhyun

Physical Medicine Rehab

16 Woodbine Ln.

Danville

PA

17822

570.271.6621

Ahsan

Irfan

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Ali

Syed

Neurology

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Alvi

Madha

Endocrinology

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6211

Amin

Mayur

Physical Medicine Rehab

2 Rehab Ln.

Danville

PA

17822-2414

570.271.6110

Avila

Jose

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Ayers

Michael

Pulmonology

100 N. Academy Ave.

Danville

PA

17822-0111

570.271.6655

Baldwin

Kelly

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Bansal

Amit

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Baracaldo

Juan

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Baran

Heather

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Beisner

Stephanie

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Bermudez

Maria

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Bhatt

Birju

Rheumatology

100 E. Mtn. Blvd.

Wilkes-Barre

PA

18711-0027

570.808.6111?

Bhattacharya

Prianka

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2001

570.271.6045

Bhavsar

Alap

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Bishnoi

Ram

Cardiology

100 N. Academy Ave.

Danville

PA

17822-1339

570.271.6089

Blankenship

James

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.214.1991

Bleggi

Albert

TeleRadiology

3502 NW 18th Ave.

Gainesville

FL

32605

330.718.3390

Blue

Rochelle

Physician Assistant

16 Woodbine Ln.

Danville

PA

17822-5212

570.271.6700

Bowen

Thomas

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Brennan

Rebekah

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Brodginski

Alison

Infectious Disease

675 Baltimore Dr.

Wilkes-Barre

PA

18702

570.808.8889

Bucaloiu

Ion

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Burke

Greg

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1401

570.271.6164

Burnside

Joyce

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Cheema

Ahmad

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Collins

Kristi

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Corrales

Alberto

Physical Medicine Rehab

480 Central Rd.

Bloomsburg

PA

17815

570.387.6150

Correll

Cynthia

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Courtney

Malachi

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Cropf

Terry

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Cruciani

Mary

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Cummings

Christopher

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Dansoa

Yvonne

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Das

Manoj

Nephrology

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Decoskey

David

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Denio

Alfred

Rheumatology

100 N. Academy Ave.

Danville

PA

17822-2152

570.271.6416

DiMarino

Lauren

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Dittman

Lindsay

Internal Medicine

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.7399

Dometita

Dan Lawrence

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Driscoll

Michael

Psychology/Neuropsychology

100 N. Academy Ave.

Danville

PA

17822-1335

570.271.6516

Elzweig

Joel

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Feldmann

Daniel

Orthopaedics

16 Woodbine Ln.

Danville

PA

17822-5212

570.271.6700

Fesniak

Henry

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Filatov

Sergey

Physical Medicine Rehab

16 Woodbine Ln.

Danville

PA

17822

570.271.6621

Finney

Glen

Neurosurgery

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.6026

Firouzi

Masoud

Gastroenterology

675 Baltimore Dr.

Wilkes Barre

PA

18702

570.808.5780

Flansbaum

Bradley

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Friedenberg

Scott

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1412

570.271.6320

Fulmer

Brant

Urology

100 N. Academy Ave.

Danville

PA

17822-1316

570.271.6328

Fulton

Randy

Psychology/Neuropsychology

100 N. Academy Ave.

Danville

PA

17822

570.271.6320

Garg

Tullika

Urology

100 N. Academy Ave.

Danville

PA

17822-1316

570.271.6328

Gatson

Na Tosha

Neurology

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

George

Jason

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Gerringer

Janine

Nurse Practitioner

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Gotoff

Robert

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6408

Green

Jamie

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Greene

Lauren

Pediatrics

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Haak

Michael

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Hanna

David

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2111

570.271.6439

Harostock

Michael

Vascular Surgery

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6367

Haynos

William

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Heinle

Edward

Physical Medicine Rehab

16 Woodbine Ln.

Danville

PA

17822

570.271.6621

Hess

William

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Ho

Chun

Physical Medicine Rehab

2 Rehab Ln.

Danville

PA

17822-2414

570.271.6110

Hohmuth

Benjamin

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Holland

Neil

Neurology

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.6026

Horwitz

Daniel

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Hossain

Muhammad

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Hosur

Srilatha

Oncology Hematology

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.4772

Islam

Monirul

Pulmonology

100 N. Academy Ave.

Danville

PA

17822-2037

570.271.6389

Jacob

Arun

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Jeffries

Scott

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Kalra

Kartik

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Kaufman

Bryan

TeleRadiology

6574 S. Quemoy Way

Aurora

CO

80016

866.231.4773

Kelley

Nancy

Neurosurgery

549 Fair St.

Bloomsburg

PA

17815

570.416.1867

Khan

Mahmud

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Khan

Shehza

Endocrinology

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6211

Kharel

Prakash

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Killiam

Elizabeth

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Kumar

S

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Kwon

Taesung

Infectious Disease

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6408

Leese

Erika

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Leicht

Amanda

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Lim

Francis

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Lodeserto

Frank

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2037

570.271.6389

Long

Kevin

Gastroenterology

100 N. Academy Ave.

Danville

PA

17822-2170

570.271.6361

Lynch

Joseph

Oncology Hematology

100 N. Academy Ave.

Danville

PA

17822-2001

570.271.6045

Maguire

Kevin

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Maniar

Hemil

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Maqsood

Aadil

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Martin

Stanley

Infectious Disease

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6408

Marvin

Michael

General Surgery

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6214

Mathur

Hersh

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Mbih

Irene

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Mckee

Jessica

Gastroenterology

100 N. Academy Ave.

Danville

PA

17822-2111

570.271.6439

Mehr

Jagdeep

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Metza

John

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Montoya Rebellon

Juan

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Mori

Ryan

Urology

100 N. Academy Ave.

Danville

PA

17822-1316

570.271.6328

Mukhtar

Hamid

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Nagori

Maria

Infectious Disease

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6408

Ni

Yanni

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Norfolk

Evan

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Noto

Anthony

Neurology

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

O'Young

Bryan

Physical Medicine Rehab

2 Rehab Ln.

Danville

PA

17822-2414

570.271.6110

Olenginski

Thomas

Rheumatology

100 N. Academy Ave.

Danville

PA

17822-2152

570.271.6416

Oren

Jess

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Otto

Amanda

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Patel

Hardik

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Patel

Pranav

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Peckham

Andrew

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Pedroso

Claire

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Penupolu

Sudheer

Pulmonology

100 N. Academy Ave.

Danville

PA

17822-2037

570.271.6389

Pokharel

Parash

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Proctor

Will

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Rafiq

Arsalan

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Ramdas

Jagadeesh

Pediatrics - Oncology Hematology

100 N. Academy Ave.

Danville

PA

17822-1320

570.271.6848

Ramdin

Nadia

Oncology Hematology

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Rao

Parth

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2001

570.271.6045

Reider

Jodie

Endocrinology

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6211

Rockwell

Derek

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Russin

Stanley

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Samaan

Mena

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6472

Sapkota

Deepak

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-1401

570.271.6164

Schirmer

Clemens

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Schroeder

Lisa

Rheumatology

100 N. Academy Ave.

Danville

PA

17822-2152

570.271.6416

Schultz

Michael

Nephrology

100 N. Academy Ave.

Danville

PA

17822-1348

570.271.6393

Schwartz

Kenny

Neurosurgery

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.6026

Scott

Thomas

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Shaban

Eman

Nephrology

100 N Academy Ave

Danville

PA

17822

570.271.6211

Shahid

Abdullah

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Shimony

Nir

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Shull

Kathleen

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1341

570.271.6211

Singh

Deepak

Vascular Surgery

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.6020

Slotkin

Jonathan

Neurosurgery

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Smith

Henry

TeleRadiology

10413 S. Yale Ave.

Tulsa

OK

74137

717.979.7558

Solangi

Zeeshan

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Soong

Virginia

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Stoker

Laurie

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-1405

570.271.6437

Storm

Randle

Cardiology

100 N. Academy Ave.

Danville

PA

17822-2775

570.271.6523

Suk

Michael

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Sullivan

Shannon

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Tariq

Ali

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Thakur

Kamia

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Thakur

Lokendra

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2037

570.271.6389

Thompson

Angela

Internal Medicine

100 N. Academy Ave.

Danville

PA

17822-2019

570.214.9585

Tobias

Nicole

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Vought

Angela

Physician Assistant

100 N. Academy Ave.

Danville

PA

17822

570.271.6211

Wagner

Lloyd

TeleRadiology

6574 S. Quemoy Way

Aurora

CO

80016

866.231.4773

Widmaier

James

Orthopaedics

100 N. Academy Ave.

Danville

PA

17822-2130

570.271.6541

Williams

Richard

TeleRadiology

6574 S. Quemoy Way

Aurora

CO

80016

866.231.4773

Wilson

Bradley

Psychology/Neuropsychology

100 N. Academy Ave.

Danville

PA

17822-1335

570.271.6516

Wood

Lance

Dermatology

890 Poplar Church Rd., Medical Arts Bldg., Ste. 100

Camp Hill

PA

17011

717.972.4250

Zand

Ramin

Neurology

1000 E. Mtn. Blvd.

Wilkes-Barre

PA

18711

570.808.6026

Zinszer

Kathya

Podiatry

436 W. Valley Ave.

Elysburg

PA

17824

570.672.1101

Attachment B – 2020 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    
Family size Federal poverty guidelines* Income less than or equal to 300% of FPG  
1 $12,760 $0 - $38,280    
2 $17,240 $0 - $51,720    
3 $21,720 $0 - $65,160    
4 $26,200 $0 - $78,600    
5 $30,680 $0 - $92,040    
6 $35,160 $0 - $105,480
 
7 $39,640 $0 - $118,920    
8 $44,120 $0 - $132,360  

* For family units with more than 8 persons, add $4,480 for each additional person.