Community Outreach: Financial Aid

Spivey Station Surgery Center believes in making healthcare available to all and provides financial assistance for patients who are qualified. 

The following guidelines (below) have been established in compliance with the state of Georgia to determine eligibility for discount rates for individuals who cannot comply with the surgery center’s financial policy due to extenuating circumstances. 

Following submission of an application, if a patient qualifies for a discount, a written communication will be sent informing them of the final decision. Similarly, those who do not qualify will also be notified in writing. All patients, regardless of qualifications, have the opportunity to apply for Care Credit financing as well.

Download a Financial Aid Application          Ask Financial Aid a Question  

Financial Aid Qualifications

Certain requirements must be met in order to be eligible for a discount. 

For a 75% discount the patient must: 

Return a completed application with documentation that meets the guidelines herein:

 

A.    Patient’s income level is between 150% and 175% of the Federal Poverty Guidelines (FPG) and

B.     Be ineligible for Medicaid

C.     Does not have third party coverage or other sources available for payment or

D.    Has third party coverage which provides limited payment, and have extenuating circumstances (i.e., unemployment, extended illness) resulting in an inability to pay for charges not covered by other sources.

Family Size	150 % of FPG		175% of FPG
	Year	Month	Year	Month
1	$ 13,290.00	$ 1,108.00	$ 15,505.00	$ 1,292.00
2	$ 17,910.00	$ 1,493.00	$ 20,895.00	$ 1,741.00
3	$ 22,530.00	$ 1,878.00	$ 26,285.00	$ 2,190.00
4	$ 27,150.00	$ 2,263.00	$ 31,675.00	$ 2,640.00
5	$ 31,770.00	$ 2,648.00	$ 37,065.00	$ 3,089.00
6	$ 36,390.00	$ 3,033.00	$ 42,455.00	$ 3,538.00
7	$ 41,010.00	$ 3,418.00	$ 47,845.00	$ 3,987.00
8	$ 45,630.00	$ 3,803.00	$ 53,235.00	$ 4,436.00
*	$ 4,620.00	$ 385.00	$ 5,390.00	$   449.00

 

For a 50% discount the patient must:

 

Return a completed application with documentation that meets the guidelines herein:

 

A.    Patient’s income level is between 185% to 200% of the Federal Poverty Guidelines (FPG) and

B.     Be ineligible for Medicaid or does not have third party coverage or other sources available for payment or

C.     Has third party coverage which provides limited payment, and have extenuating circumstances (i.e., unemployment, extended illness) resulting in an inability to pay for charges not covered by other sources.

Family Size	185 % of FPG		200% of FPG
	Year	Month	Year	Month
1	$ 16,391.00	$ 1,366.00	$ 17,720.00	$ 1,477.00
2	$ 22,089.00	$ 1,841.00	$ 23,880.00	$ 1,990.00
3	$ 27,787.00	$ 2,316.00	$ 30,040.00	$ 2,503.00
4	$ 33,485.00	$ 2,790.00	$ 36,200.00	$ 3,017.00
5	$ 39,183.00	$ 3,265.00	$ 42,360.00	$ 3,530.00
6	$ 44,881.00	$ 3,740.00	$ 48,520.00	$ 4,043.00
7	$ 50,579.00	$ 4,215.00	$ 54,680.00	$ 4,557.00
8	$ 56,277.00	$ 4,690.00	$ 60,840.00	$ 5,070.00
*	$ 5,698.00	$ 475.00	$ 6,160.00	$   513.00

 

For a 25% discount the patient must:

 

(a) Return a completed application with documentation that meets the guidelines herein:

 

a.      Patient’s income level is between 235% to 250% of the Federal Poverty Guidelines (FPG) and

b.     Be ineligible for Medicaid and does not have third party coverage or other sources available for payment or

c.      Has third party coverage which provides limited payment, and have extenuating circumstances (i.e., unemployment, extended illness) resulting in an inability to pay for charges not covered by other sources.

 

Family Size	235 % of FPG		250% of FPG
	Year	Month	Year	Month
1	$ 20,821.00	$ 1,735.00	$ 22,150.00	$ 1,846.00
2	$ 28,059.00	$ 2,338.00	$ 29,850.00	$ 2,488.00
3	$ 35,297.00	$ 2,941.00	$ 37,550.00	$ 3,129.00
4	$ 42,535.00	$ 3,545.00	$ 45,250.00	$ 3,771.00
5	$ 49,773.00	$ 4,148.00	$ 52,950.00	$ 4,413.00
6	$ 57,011.00	$ 4,751.00	$ 60,650.00	$ 5,054.00
7	$ 64,249.00	$ 5,354.00	$ 68,350.00	$ 5,696.00
8	$ 71,487.00	$ 5,957.00	$ 76,050.00	$ 6,339.00
*	$ 7,238.00	$ 603.00	$ 7,700.00	$   642.00