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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 The Rehabilitation Institute of St. Louis, an affiliation of BJC Healthcare and Encompass Health 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 The Rehabilitation Institute of St. Louis, an affiliation of BJC Healthcare and Encompass Health and who may bill you separately. These providers are encouraged, but not required, to follow the financial assistance policy of The Rehabilitation Institute of St. Louis, an affiliation of BJC Healthcare and Encompass Health. 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 The Rehabilitation Institute of St. Louis, an affiliation of BJC Healthcare and Encompass Health is provided below.

You may request from The Rehabilitation Institute of St. Louis, an affiliation of BJC Healthcare and Encompass Health 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 314.658.3800 and ask to speak with Credentialing, so that we can assist you with the most current and accurate information.

03015900_StLouis
Last Name
First Name
Specialty
Address
City
St
ZIP
Phone

Abbas

Shazia

Internal Medicine

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Ali

Asim

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Alonso

James

Neurology

3009 N Ballas Rd

St. Louis

MO

63131

314.487.3155

Atwood

Crystal

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Awobuluyi

Marc

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Barkoviak

Michael

Pulmonology

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Berger

Carol

Nurse Practitioner

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Bertagnolli

Reono

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Binder

Ellen

Internal Medicine

660 S Euclid Ave Campus Box 8303

St Louis

MO

63108

314.286.2700

Boatman

Jeffrey

Nurse Practitioner

1201 Bellevue Ave

St. Louis

MO

63117

314.647.4488

Bochicchio

Grant

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Brinkmeier

Matthew

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Brook

Alan

Pulmonology

6 Jungermann Cir Ste 210

St Peters

MO

63376

636.441.6056

Buckman

Sara

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Camacho-Soto

Alejandra

Physical Medicine & Rehab

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Carpenter

David

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Carr

David

Internal Medicine

660 S Euclid Ave Campus Box 8303

St Louis

MO

63108

314.286.2700

Carter

Alexandre

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Chang

Dennis

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Chang

Ping

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Chen

Ying

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Cheng

Steven

Nephrology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Claxton

Matthew

Podiatry

4201 S Cloverleaf Dr Suite A

St Peters

MO

63376

636.928.1240

Cummings-Vaughn

Lenise

Internal Medicine

4921 Parkview 10th Floor Mail Stop 90-35-706

St. Louis

MO

63110

314.362.1615

Darken

Rachel

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Darsi

Lakshman

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Day

Gregory

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Dembiec

Scott

Internal Medicine

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Dosenbach

Nico

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Dyk

Piotr

Nephrology

330 First Capitol Dr Ste 340

St Charles

MO

63301

636.946.9719

Eaton

Stephen

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Elles-Borrson

Lisa

Nurse Practitioner

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Ewald

Gregory

Cardiology

660 S Euclid Box 8086

St. Louis

MO

63110

314.454.7009

Faulk

Carol

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Filson-Pinkley

Kathryn

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Fink

Mary

Nurse Practitioner

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Fong

Wing Man

Psychology/Neuropsychology

444 Forest Park Ave Campus Box 8518

St Louis

MO

63108

314.454.7756

Ford

Andria

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Freeman

Bradley

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Freer

James

Internal Medicine

660 S Euclid Box 8066

St. Louis

MO

63110

314.747.1617

Fucetola

Robert

Psychology/Neuropsychology

444 Forest Park Ave Campus Box 8518

St Louis

MO

63108

314.454.7756

Giles

James

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Goldberg

Seth

Nephrology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Goldstein

Gary

Pulmonology

6 Jungermann Cir Ste 210

St Peters

MO

63376

636.441.6056

Gunapooti

Mahendra

Physical Medicine & Rehab

261 Dunn Rd

St Louis

MO

63031

314.830.2600

Gupta

Anjali

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Hakim

Ashfaq

Gastroenterology

1115 Dunn Rd Ste 212E 6 Jungerman cl st peters Mo 63176

St Louis

MO

63136

314.837.4200

Hampton

Naomi

Nurse Practitioner

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Haque

Zahirul

Internal Medicine

4 Clayton Court Drive

St. Louis

MO

63131

314.368.3422

Harsy

Kimberly

Nurse Practitioner

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Hartweger

John

Internal Medicine

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Hegde

Bijoy

Physical Medicine & Rehab

2044 Madison Avenue; Suite 15 Dept of Physical Medicine and Rehab

Granite City

IL

62040

618.451.1500

Herndon

Jennifer

Physician Assistant

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Hinz

Michael

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Holden

Timothy

Geriatric Medicine

660 S Euclid Ave Campus Box 8303

St Louis

MO

63108

314.286.2700

Holtzman

David

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Holzum

Neal

Internal Medicine

2536 South Old Highway 94 Ste 224

St Charles

MO

63303

636.236.9945

Houchin

Aubra

Family Medicine

408 Jungermann Rd

St Peters

MO

63376

636.449.5757

Huskey

Thy

Physical Medicine & Rehab

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Ilahi

Obeid

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Ishiyama

Takaaki

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Jacob

Sindhu

Physical Medicine & Rehab

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Jacobs

Myron

Pulmonology

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Jarad

George

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Ji

Joyce

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Johnson

Michael

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Ju

Yo-El

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Juknis

Henrikas

Nephrology

6 Jungermann Circle Ste 215 Suite 215

St Peters

MO

63376

636.928.0123

Juknis

Neringa

Physical Medicine & Rehab

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Kachevas

Elysha

Nurse Practitioner

6 Jungermann Cir Ste 210

St Peters

MO

63376

636.441.6056

Kao

Patricia

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Khann

Mehreen

Internal Medicine

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Khariton

Boris

Physical Medicine & Rehab

PO Box 411091

St. Louis

MO

63141

314.667.5535

Khoury

Charbel

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Kirby

John

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Koraishy

Farrukh

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Krause

Keith

Physician Assistant

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Kuehn

Nicolaus

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Li

Tingting

Nephrology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Lin

Michael

Internal Medicine

660 S Euclid Campus Box 8121

St. Louis

MO

63110

314.747.4653

Loftspring

Matthew

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Long

Justin

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Lucey

Brendan

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Mahoney

Robert

Internal Medicine

660 S Euclid Campus Box 8121

St. Louis

MO

63110

314.747.4653

Marlow

Kathryn

Physical Medicine & Rehab

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Massay

Irim

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Mazuski

John

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Mazzoni

Pietro

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

McDonough

Cheryl

Internal Medicine

660 S Euclid Box 8058

St. Louis

MO

63110

314.362.1700

Meyermann

Mark

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Miller

Brent

Nephrology

4205 Forest Park Ave

St. Louis

MO

63108

314.286.0801

Miller

Luann

Nurse Practitioner

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Mir

Yasser

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Musiek

Erik

Neurology

660 S Euclid Ave Campus Box 8303

St Louis

MO

63108

314.286.2700

Mutneja

Anubha

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Naeem

Muhammad

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Nagaraj

Devika

Internal Medicine

211 Saint Francis Dr

Cape Girardeau

MO

63703

573.331.5770

Naismith

Robert

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Najam

Nadeem

Internal Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Newman

Jack

TeleCardiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Nguyen

David

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Nitz

Leann

Nurse Practitioner

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

O'Brien

Frank

Nephrology

660 S Euclid Ave Campus Box 8126

St Louis

MO

63110

314.362.7603

Odom

Devin

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Okabe

Akiko

Nurse Practitioner

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Patel

Pratul

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Patri

Manokiran

Infectious Disease

10004 Kennerly Rd Ste 171B

St. Louis

MO

63128

314.821.0900

Patton

Mariah

Physician Assistant

201 BJC St Peters Dr Ste 200

Saint Peters

MO

63376

636.916.7060

Pham

Justin

TeleRadiology

1620 Northwest Blvd Ste 202

Coeur d'Alene

ID

83814

208.292.4323

Phan

Uyen

Family Medicine

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Pierce

Ann

Nurse Practitioner

6 Jungermann Cir Ste 210

St Peters

MO

63376

636.441.6056

Punch

Laurie

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Racette

Brad

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Raja

Furqan

Nephrology

70 Jungermann Cir Ste 405

Saint Peters

MO

63376

636.720.0310

Rey

Adina

Nurse Practitioner

12125 Woodcrest Executive Dr Ste 210

St. Louis

MO

63141

314.317.0600

Richard

Lois

Internal Medicine

660 S Euclid Campus Box 8121

St. Louis

MO

63110

314.747.4653

Rothstein

Marcos

Nephrology

4205 Forest Park Ave

St. Louis

MO

63108

314.286.0801

Ruck

Lela

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Ruvinskaya

Rimma

Physical Medicine & Rehab

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Sauer

Jacqueline

Nurse Practitioner

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Schindler

Suzanne

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Schuerer

Douglas

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Singer

Gary

Nephrology

70 Jungermann Cir Ste 405

Saint Peters

MO

63376

636.720.0310

Sky

Adam

Psychiatry

1201 Bellevue Ave

St Louis

MO

63117

314.647.4488

Sommerville

Richard

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Stahlheber

Casey

Pulmonology

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Stegemeier

Marcee

Nurse Practitioner

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Thebeau

April

Internal Medicine

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Tiu

Jonathan

Neurology

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Turnbull

Isaiah

General Surgery

660 S Euclid Campus Box 8109

St Louis

MO

63110

314.951.8149

Turpin

Frederick

Physical Medicine & Rehab

201 BJC St Peters Dr Ste 200

Saint Peters

MO

63376

636.916.7060

Tyler

Tia Giovanna

Nurse Practitioner

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Van Stavern

Renee

Neurology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Velloze

Stephanie

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Vijayan

Anitha

Nephrology

660 S. Euclid Campus Box 8126

St. Louis

MO

63110

314.362.7211

Volshteyn

Oksana

Physical Medicine & Rehab

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Werner

Nicole

Psychology/Neuropsychology

660 S Euclid Campus Box 8111

St. Louis

MO

63110

314.362.5954

Wice

Martin

Physical Medicine & Rehab

4444 Forest Park Campus Box 8518

St Louis

MO

63108

314.454.7757

Wilmsen-Craig

Christine

Internal Medicine

12647 Olive Blvd. #600

St. Louis

MO

63141

314.317.0600

Yee

Derek

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Yong

Lee

Infectious Disease

10004 Kennerly Rd Ste 171B

St. Louis

MO

63128

314.821.0900

Younce

Danicela

Internal Medicine

4523 Clayton Ave Campus Box 8058

St Louis

MO

63110

314.362.1700

Young

Daniel

Nephrology

70 Jungermann Cir Ste 405

Saint Peters

MO

63376

636.720.0310

Young

Zachary

Pulmonology

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Zakari

Noura

Nurse Practitioner

5870 N Hiatus Rd Ste 200

Tamarac

FL

33321

954.377.3060

Zuick

Scott

Pulmonology

6 Jungermann Cir Ste 210

St Peters

MO

63376

636.441.6056

Zweig

William

Pulmonology

11133 Dunn Rd Ste 2335

St Louis

MO

63136

314.635.5007

Attachment B – 2019 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 $12,490 $0 - $24,980 $24,981 - $37,470 $37,471 - $48,560
2 $16,910 $0 - $33,820 $33,821 - $50,730 $50,731 - $65,840
3 $21,330 $0 - $42,660 $42,661 - $63,990 $63,991 - $83,120
4 $25,750 $0 - $51,500 $51,501 - $77,250 $77,251 - $100,400
5 $30,170 $0 - $60,340 $60,341 - $90,510 $90,511 - $117,680
6 $34,590 $0 - $69,180 $69,181 - $103,770 $103,771 - $134,960
7 $39,010 $0 - $78,020 $78,021 - $117,030 $117,031 - $152,240
8 $43,430 $0 - $86,860 $86,861 - $130,290 $130,291 - $169,520

* For family units with more than 8 persons, add $4,420 for each additional person.