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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 Sunrise 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 Sunrise 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 Sunrise. 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 Sunrise is provided below.

You may request from Encompass Health Rehabilitation Hospital of Sunrise 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

Alberts

Alan

Rheumatology

7431 N University Dr. Suite#300

Tamarac

FL

33321

954.724.5560

Ali

Aaliya

Nurse Practitioner

1000 West Sample Rd Ste A

Coral Springs

FL

33065

954.798.7114

Allaf

Waddah

Pulmonology

20200 W Dixie Highway 1108

Miami

FL

33180

305.949.6003

Alvarez

Jose

Pulmonology

201 NW 82nd AVE Suite105

Plantation

FL

33324

954.476.8420

Angles-Hermoza

Victor

Nurse Practitioner

2901 Coral Hill Dr. Suite#360

Coral Springs

FL

33065

954.255.7310

Ansari

Firdose

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Arias

Yasnay

Nurse Practitioner

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Armstrong

Linda

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Arriaga

Danielle

Nurse Practitioner

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Aviles

Xavier

Physical Medicine Rehab

2525 SW 75th Avenue

Miami

FL

33155

512.255.9494

Barcena Blanch

Luis

Infectious Disease

2825 N State Rd 7 Suite 305

Margate

FL

33063

954.366.4910

Barrero

Jorge

Nephrology

5700 N Federal Hwy Suite 6

Ft. Lauderdale

FL

33305

954.958.7576

Barrero

Jorge

Nephrology

5700 N Federal Hwy Suite 6

Ft. Lauderdale

FL

33305

954.958.7576

Becerra Maertens

Jose

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Bell

John

Physical Medicine Rehab

1 W Sample Rd Suite 207

Deerfield Bch

FL

33064

954.946.3298

Berman

Blake

TeleRadiology

8360 W Flagler ST Suite 207

Miami

FL

33144

877.404.0333

Bernstein

Jacquelyn

Physician Assistant

1400 NE Miami Gardens Dr Ste 105

North Miami Beach

FL

33179

305.974.5933

Bierzynski

Adam

Cardiology

7050 NW 4th St Ste 101

Plantation

FL

33317

954.581.4112

Blake

Donald

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Blanco

Lenette

Nurse Practitioner

8251 W Broward Blvd Ste 103

Plantation

FL

33324

954.255.7310

Bloomgarden

Jessica

Physical Medicine Rehab

109 Montclaire Dr.

Weston

FL

33326

954.746.1505

Boyarin

Brian

Physician Assistant

7421 N University Dr Suite211-212

Tamarac

FL

33321

954.721.9494

Camargo Salcedo

Reinaldo

Internal Medicine

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Carbonnell

Juan

Nephrology

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Cardenas

Raul

Physical Medicine Rehab

13941 Oak Ridge Dr

Davie

FL

33325

954.414.5238

Cepelowicz

Juliana

Pulmonology

1001 S Andrews AVE Suite 100

Ft. Lauderdale

FL

33316

954.906.6000

Chaleff

Frederick

Cardiology

7050 NW 4th St Ste 101

Plantation

FL

33317

954.581.4112

Chamsuddin

Abbas

TeleRadiology

6245 N Federal Hwy Suite#500

Ft. Lauderdale

FL

33309

888.886.5238

Chervony

Daniel

Psychiatry

7431 N University Dr. Suite#204

Tamarac

FL

33321

954.720.7999

Chitopoulos

Cassandra

Physician Assistant

7421 N University Dr Suite211-212

Tamarac

FL

33321

954.721.9494

Cohen

Tiffany

Nurse Practitioner

1001 S Andrews AVE Suite 100

Ft. Lauderdale

FL

33316

954.906.6000

Connor

Lyne

Nurse Practitioner

8393 W Oakland Pk Blvd

Sunrise

FL

33351

954.741.3335

Cuffy

Cherison

Podiatry

7301 N University Dr Suite 305

Tamarac

FL

33321

954.721.4806

Cuffy

Sharon

Podiatry

7301 N University Dr Suite 305

Tamarac

FL

33321

954.721.4806

Davis

Michelle

Nurse Practitioner

1000 West Sample Rd Ste A

Coral Springs

FL

33065

954.798.7114

Diab Agha

Samer

Nephrology

6268 North Federal hwy

Ft Lauderdale

FL

33316

954.880.5553

Doan

Bao Tran

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Echeverri

Diego

Nephrology

2951 NW 49th AVE Suite#101

Lauderdale Lakes

FL

33313

954.739.2511

Eglante

Noel

Nurse Practitioner

1400 NE Miami Gardens Dr Ste 105

North Miami Beach

FL

33179

305.974.5933

El Kassem

Mohamad

Nephrology

1000 West Sample Rd Ste A

Coral Springs

FL

33065

954.798.7114

English

Scott

Family Medicine

16470 NE 10th Ave

North Miami Beach

FL

33162

305.651.9988

Eyma-Heywood

Valerie

Family Medicine

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Fernandes

Hilaire

Cardiology

7050 NW 4th St Ste 101

Plantation

FL

33317

954.581.4112

Fernandez

Victor

Nephrology

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Fisher

Antoinette

Nurse Practitioner

1400 NE Miami Gardens Dr Ste 105

North Miami Beach

FL

33179

305.974.5933

Flores

Elmer

Physician Assistant

7431 N University Dr Suite 110

Tamarac

FL

33321

954.726.0035

Fox

Richard

Nephrology

7171 N Univ Dr. Suite#203

Tamarac

FL

33321

954.721.4300

Frady

Ivonne

Nurse Practitioner

8329 W sunrise Blvd

Plantation

FL

33322

954.624.1617

Frank

Daniel

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Gadh

Rajdeep

Nephrology

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Galdames

Mario

Family Medicine

2901 Coral Hill Dr. Suite#360

Coral Springs

FL

33065

954.255.7310

Galindo

Diana

Geriatric Medicine

2950 Cleveland Clinic Blvd

Weston

FL

33331

954.659.5867

Gelfond

Dillobar

Internal Medicine

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Goodwin

Patricia

Physical Medicine Rehab

7300 N Kendall Drive Suite 720

Miami

FL

33156

877.749.7428

Gopalaswamy

Ramesh

Neurology

260 SW 84th Avenue Suite C

Plantation

FL

33324

954.361.3116

Gray

Marlene

Psychology/Neuropsychology

8890 W Oakland Pk BLVD Suite#103

Oakland Pk

FL

33351

954.742.7032

Green

Suzanne

Psychology/Neuropsychology

4399 Nob Hill Rd.

Sunrise

FL

33351

954.746.8415

Grimm

Eric

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Guevara

Rodolfo

Internal Medicine

5800 Colonial Dr

Margate

FL

33063

561.931.3941

Gupta

Bharat

Nephrology

911 East Oakland Park Blvd

Oakland Park

FL

33334

954.727.2200

Gupta

Mohan

Internal Medicine

8384 Oakland Pk BLVD

Sunrise

FL

33351

954.742.0112

Halpert

Elias

Rheumatology

7431 N University Dr. Suite#300

Tamarac

FL

33321

954.724.5560

Hedayati

Amir

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Henley-Seymour

Andrea

Pain Management - Medical Management

21097 NE 27th Court Suite 350

Aventura

FL

33180

305.974.5533

Herrada

Alberto

Podiatry

10600 Griffin Rd. Suite#107A

Cooper City

FL

33328

954.434.9877

Hull

Frank

Pulmonology

1625 SE 3rd Ave Suite 600

Ft Lauderdale

FL

33316

954.522.7226

Hwee

Yin

Wound Care

1201 N 35th Ave Suite 200

Hollywood

FL

33021

954.987.8100

Jacob

Radu

Nephrology

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Jain

Mudit

Endocrinology

300 NW 70th AVE Suite#105

Plantation

FL

33317

954.585.6292

Jancko

Joel

Cardiology

7050 NW 4th St Ste 101

Plantation

FL

33317

954.581.4112

John

Jones

Nephrology

7351 W Oakland Park Blvd Suite 105

Lauderhill

FL

33319

954.908.5992

Justilien

Elsie

Nurse Practitioner

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Kalirao

Paramjit

Nephrology

5441 N University Drive Suite 101

Coral Springs

FL

33067

954.739.2221

Kalman

Alfred

Oncology Hematology

7431 N University Dr Suite 110

Tamarac

FL

33321

954.726.0035

Kamholtz

Robert

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Kaplan

Glenn

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Kaylin

Mark

Nephrology

333 NW 70th Ave Suite 107A

Plantation

FL

33317

954.581.0200

Khan

Tanzeela

Internal Medicine

2400 N University Drive Ste 215

Pembroke Pines

FL

33024

Killian

Robert

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Kimmel

Steven

Rheumatology

7431 N University Dr. Suite#300

Tamarac

FL

33321

954.724.5560

Kowalski

Ian

Internal Medicine

6816 Griffin Road

Davie

FL

33314

954.600.3163

Kravitz

Jack

Family Medicine

5150 NW 82nd Terrace

Coral Springs

FL

33067

754.702.5348

Ledford

Jamie

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Lerner

Lauren

Physical Medicine Rehab

4399 Nob Hill Rd.

Sunrise

FL

33351

954.746.1505

Leventhal

Beth

Nephrology

2951 NW 49th AVE Suite#101

Lauderdale Lakes

FL

33313

954.739.2511

Levy

Galit

Physical Medicine Rehab

4399 Nob Hill Rd.

Sunrise

FL

33351

954.746.1338

Lipkin

Stephen

Gastroenterology

8329 W sunrise Blvd

Plantation

FL

33322

954.624.1617

Lopez

Carlos

Internal Medicine

1901 Bayview Dr

Ft Lauderdale

FL

33305

754.444.9447

Lopez

Juan

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mais

Tatiana

Nurse Practitioner

2900 N Military Trail 210

Boca Raton

FL

33431

561.931.3941

Majid

Mazhar

Cardiology

7737 N University Dr Suite 104

Tamarac

FL

33321

954.720.1930

Malpartida

Freddy

Nephrology

722 Riverside Dr.

Coral Springs

FL

33071

954.345.4333

Mandell

Kenneth

Cardiology

15300 Jog Rd Suite 202

Delray Beacch

FL

33446

561.455.5601

Marcus

Daniel

Cardiology

7646 Nob Hill Rd

Tamarac

FL

33321

954.484.0800

Marigowda

Shobha

Nurse Practitioner

2951 NW 49th Ave

Lauderdale Lakes

FL

33313

954.717.4066

Martin

Andrew

Infectious Disease

2825 N State Rd 7 Suite 305

Margate

FL

33063

954.366.4910

Martin

Edouard

Nephrology

2951 NW 49th AVE Suite#101

Lauderdale Lakes

FL

33313

954.739.2511

Masood

Shahid

Physician Assistant

4469 N SR 7

Lauderdale Lakes

FL

33319

954.486.1966

Mata

Maria

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mazer

Harvey

Optometry

2863 Executive Park Dr Suite 103

Weston

FL

33331

954.217.2992

Medina

Julian

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mendez

Fernando

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mendez

Kevin

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mendez

Oscar

Family Medicine

2951 NW 49th Ave Suite 306

Lauderdale Lakes

FL

33313

954.717.4066

Mizrachi

David

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Mosca

Heather

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Nana

Maher

Internal Medicine

1400 NE Miami Gardens Dr Ste 105

North Miami Beach

FL

33179

305.974.5933

Nanavati

Kunal

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Nevares

Ibiza

Physical Medicine Rehab

7100 W Commercial BLVD Suite#105

Lauderhill

FL

33319

954.578.2292

Nieves

Jose

Pulmonology

10794 Pines Blvd Ste 205

Pembroke Pines

FL

33026

954.538.8543

Nochimson

Ross

Internal Medicine

4994 N University Drive

Lauderhill

FL

33351

954.748.9300

Nochimson

Sean

Internal Medicine

4994 N University Drive

Lauderhill

FL

33351

954.748.9300

Noe

Terri

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Occy

France

Family Medicine

757 SE 17th Street Suite 1228

Fort Lauderdale

FL

33316

305.904.7876

Onsorio

Marcela

Nurse Practitioner

8251 W Broward Blvd Ste 103

Plantation

FL

33324

954.255.7310

Orina

Fridah

Nurse Practitioner

1400 NE Miami Gardens Dr Ste 105

North Miami Beach

FL

33179

305.974.5933

Owens

David

TeleRadiology

8360 W Flagler ST Suite 207

Miami

FL

33144

305.220.0333

Pappas

Alexandros

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Patel

Dhruv

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Patel

Rushi

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Patsiornik

Alexander

Nurse Practitioner

2950 Cleveland Clinic BLVD

Weston

FL

33331

954.659.5353

Pearlmutter

Nina

Internal Medicine

15814 W State Rd 84

Sunrise

FL

33326

954.384.7200

Pearlson

Jonathan

Psychology/Neuropsychology

8890 W Oakland Pk BLVD Suite#103

Sunrise

FL

33351

954.742.7032

Pierre

Rock

Nurse Practitioner

2951 NW 49th Ave

Lauderdale Lakes

FL

33313

954.717.4066

Puller

Donald

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Queiroz

Thiago

Physical Medicine Rehab

3944 NW 82nd Way

Pembroke Pines

FL

33024

Railey

Dean

Gastroenterology

8329 W sunrise Blvd

Plantation

FL

33322

954.624.1617

Rajter

Jean-Jacques

Pulmonology

1001 S Andrews AVE Suite 100

Ft. Lauderdale

FL

33316

954.906.6000

Ramirez Melendez

Ramon

Infectious Disease

7421 N University Dr Suite211-212

Tamarac

FL

33321

954.721.9494

Reitman

Laurence

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Richter

Stanley

Cardiology

7401 N University Dr Suite 204

Tamarac

FL

33321

954.721.6200

Rivera-Morales

Roberto

TeleRadiology

8360 W Flagler ST Suite 207

Miami

FL

33144

877.404.0333

Rodriguez

Ignacio

Otolaryngology

4850 W Oakland Pk BLVD Suite#102

Lauderdale Lakes

FL

33313

954.486.4180

Rodriguez

Yamel

Nurse Practitioner

8251 W Broward Blvd Suite 103

Plantation

FL

33324

954.255.7310

Ross

Sheldon

Podiatry

10109 W Oakland Pk Bvld.

Sunrise

FL

33351

954.748.9444

Ruddy

Michael

Orthopaedics

1625 SE 3rdAVE Suite#700

Ft. Lauderdale

FL

33301

954.463.3200

Rush

Joel

Orthopaedics

1960 NE 47 street suite 200

Ft Lauderdale

FL

33308

954.463.3200

Rzadkowolsky-Raoli

Ilan

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Said

Binor

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Sandler

Richard

Nephrology

201 NW 70th Ave Suite A

Plantation

FL

33317

954.583.1151

Santana

Niurka

Psychology/Neuropsychology

4399 Nob Hill Rd.

Sunrise

FL

33351

954.315.3405

Sardinas

Giezy

Internal Medicine

4148 SW 130th Ave

Davie

FL

33330

786.314.1318

Sareh

Sam

Cardiology

333 NW 70th Ave Suite 116

Plantation

FL

33317

954.581.6041

Sassoon

Eddie

Physical Medicine Rehab

10011 Pines BLVD Stuite#201

Pembroke Pines

FL

33024

954.748.7474

Schiff

Janice

Nurse Practitioner

7431 N University Drive Ste 204

Tamarac

FL

33321

954.720.7999

Schwartz

Aaron

Pulmonology

8890 W Oakland Pk BLVD Suite 100

Sunrise

FL

33351

954.749.7117

Schwartz

Alan

Cardiology

8393 W Oakland Pk BLVD

Sunrise

FL

33351

954.741.3335

Sebastian

Thomas

Infectious Disease

7421 N University Dr Suite211-212

Tamarac

FL

33321

954.721.9494

Seth

Raghav

Cardiology

7421 NW 4th ST

Plantation

FL

33317

954.616.5593

Seymour

Amir

Physical Medicine Rehab

4399 Nob Hill Rd.

Sunrise

FL

33351

954.746.1338

Shea

Jessica

Nurse Practitioner

5700 N Federal Highway Suite 6

Fort Lauderdale

FL

33308

954.958.7576

Sheinbaum

William

Cardiology

7401 N University Dr Suite 204

Tamarac

FL

33321

954.721.6200

Shilling

Diane

Nurse Practitioner

1001 S Andrews AVE Suite 100

Ft. Lauderdale

FL

33316

954.906.6000

Shiman

Alexander

Internal Medicine

7421 N University Dr. Suite #305

Tamarac

FL

33321

954.722.3200

Shulman

Joel

Cardiology

333 NW 70th Ave Suite 116

Plantation

FL

33317

954.581.6041

Siddiqui

Mohsin

Internal Medicine

201 NW 82 Avenue Suite 201

Plantation

FL

33324

954.350.1247

Sierra

Karen

Geriatric Medicine

2950 Cleveland Clinic BLVD

Weston

FL

33331

954.659.5353

Simon

Robin

Orthopaedics

4101 NW 4th ST Suite#305

Plantation

FL

33317

954.925.7333

Singal

Robert

Cardiology

333 NW 70th Ave Suite 116

Plantation

FL

33317

954.581.6041

Smoller

Scott

Nephrology

180 SW 84th Ave Suite C

Plantation

FL

33324

954.452.5188

Spoliansky

Gabriel

TeleRadiology

7700 W Sunrise BLVD

Plantation

FL

33321

954.939.5671

Steffen

Corinne

Physician Assistant

6268 North Federal hwy

Ft Lauderdale

FL

33316

954.880.5553

Stone

Kevin

Orthopaedics

7431 N University Dr. Suite#300

Tamarac

FL

33321

954.724.5560

Subramanian

Veena

Neurology

260 SW 84th Avenue Suite C

Plantation

FL

33324

954.361.3116

Suite

Nicholas

Neurology

11860 W State Rd. 84 Suite#B10

Davie

FL

33325

954.626.0617

Tannenbaum

Scott

Physical Medicine Rehab

4399 Nob Hill Rd.

Sunrise

FL

33351

954.746.1338

Tourgeman

Kenneth

Nephrology

5441 N University Drive Suite 101

Coral Springs

FL

33067

954.739.2221

Urbandt

Pablo

Cardiology

7050 NW 4th St Ste 101

Plantation

FL

33317

954.581.4112

Vanderploeg Nolan

Katherine

Nurse Practitioner

5700 N Federal Hwy Suite 6

Ft. Lauderdale

FL

33305

954.958.7576

Vidalon

Carlos

Endocrinology

201 NW 82nd AVE Suite#504

Plantation

FL

33324

954.625.6778

Wachsman

Seth

Pain Management - Medical Management

8880 Royal Palm BLVD Suite#103

Coral Springs

FL

33065

954.975.8233

Wang

Christina

Physician Assistant

7431 N University Dr Suite 110

Tamarac

FL

33321

954.726.0035

Werner

Barry

Cardiology

7421 N University Dr. Suite#305

Tamarac

FL

33321

954.722.2000

Zagha

Ralph

Urology

2951 NW 49th Ave Suite 205

Lauderdale Lakes

FL

33313

954.652.0246

Zelfman

Mikhail

Family Medicine

757 SE 17 Street Suite 1228

Fort Lauderdale

FL

33316

954.663.5066

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 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 $12,760 $0 - $25,520 $25,521 - $38,280 $38,281 - $51,040
2 $17,240 $0 - $34,480 $34,481 - $51,720 $51,721 - $68,960
3 $21,720 $0 - $43,440 $43,441 - $65,160 $65,161 - $86,880
4 $26,200 $0 - $52,400 $52,401 - $78,600 $78,601 - $104,800
5 $30,680 $0 - $61,360 $61,361 - $92,040 $92,041 - $122.720
6 $35,160 $0 - $70,320 $70,321 - $105,480 $105,481 - $140,640
7 $39,640 $0 - $79,280 $79,281 - $118,920 $118,921 - $158,560
8 $44,120 $0 - $88,240 $88,241 - $132,360 $132,361 - $176,480

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