Financial Information

Access for Every Patient.

Vista Plains Health does not discriminate in the provision of services to an individual (i) because the individual is unable to pay; (ii) because payment for those services would be made under Medicare, Medicaid or the Children’s Health Insurance Program (CHIP); or (ii) based upon the individual’s race, color, sex, national origin, disability, religion, or sexual orientation.

IRC Section 501(r)(5) requires that hospitals limit charges for emergency and other medically necessary care provided to individuals eligible for financial assistance to be no more than amounts generally billed (ABG) to insured individuals.

• Vista Plains Health places notification of Sliding Fee Discount Program in the clinic waiting area.
• An explanation of our Sliding Fee Discount Program and our application form are available on Vista Plains Health’s website.
• Sliding Fee Discount Program application will be included when balances are due and payment arrangements have not been made. Copies of Vista Plains Health financial assistance program will be placed at the clinic, by the emergency room, by the business office and on the Vista Plains Health website.
• Sliding Fee Discount Program application will be included when balances are due and payment arrangements have not been made.

Vista Plains Health’s compassionate care is secondary to all other third parties and financial resources available to the patient.

The following percentages will be given to patients with a total household income as follows.

• Income less than 125% of federal poverty level will receive 100% financial assistance.
• Income between 126%-150% of federal poverty level will receive 80% financial assistance.
• Income between 151%-175% of the federal poverty level will receive 60% financial assistance.
• Income between 176%-200% of the federal poverty level will receive 40% financial assistance.
• Income greater than 200% of the federal poverty level will receive 0% financial assistance.

To this end, we have adopted reasonable guidelines with respect to the provision of health care services to patients who are determined to be unable to pay for the services received. We have developed a financial assistance program that can be used as a last resort when patients have exhausted all other options for paying for the health care services received here. Vista Plains Health will always treat patients with respect and dignity while attempting to resolve their balance.

All patients must agree to be screened for benefits by completing a financial statement and/or other related paperwork in order to qualify for discounts under this program. The discounts provided under this program are based on a multitude of factors including, but not limited to, household income compared to the federal poverty levels, and changes in medical conditions. Discounts up to 100% may be granted if approved according to our policy guidelines. Vista Plains Health Financial assistance is for hardship cases and cannot be used for self-referred services.

In order to be considered for our financial assistance program, please complete all of the following and return all documents to the address below.

Financial assistance will be evaluated on a case-by-case base. Other circumstances may show that full payment of medical expenses could cause serious financial hardship to the patient or the house. These circumstances may warrant that an exceptional financial reduction be considered.

Vista Plains Health Providers that Accept Financial Assistance:

Jason Snow, PA
Amber Scally, SLP
Seth Nolan, NP
Nathanial Untalan, PT
Sara Kate Hurley, FNP
Kary Engle, PA
Jason Moore, PA
Dr. Larson
Ivan Mustafa, NP
Charles Bryan Simpson, NP
Darlene Sanders, PA
Catherine Kokoszka, PTA
Ashley Russell, NP