{"id":4491,"date":"2023-08-16T21:40:37","date_gmt":"2023-08-16T21:40:37","guid":{"rendered":"https:\/\/clearsky.wizeinteractive.com\/lecanto\/?page_id=4491"},"modified":"2026-03-06T00:54:35","modified_gmt":"2026-03-06T00:54:35","slug":"billing-and-financial-assistance-resources","status":"publish","type":"page","link":"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/","title":{"rendered":"Billing and Financial Assistance Resources"},"content":{"rendered":"<div id='layer_slider_1'  class='avia-layerslider main_color avia-shadow  avia-builder-el-0  el_before_av_one_full  avia-builder-el-first  container_wrap sidebar_right' style='  height: 151px;' ><\/div><div id='after_layer_slider_1'  class='main_color av_default_container_wrap container_wrap sidebar_right' style=' '  ><div class='container' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-4491'><div class='entry-content-wrapper clearfix'>\n<div class=\"flex_column av_one_full  flex_column_div av-zero-column-padding first  avia-builder-el-1  el_after_av_layerslider  el_before_av_one_full  avia-builder-el-first  \" style='border-radius:0px; '><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: center;\"><a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#billing\">Billing &amp; Collections<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#policy\">Financial Assistance Policy<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#guidelines\">Financial Assistance Discount Guidelines<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#application\">Financial Hardship Application<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#hardship\">Financial Hardship Application Assistance<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#statement\">Request Itemized Statement<\/a> | <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#contact\">Physician &amp; Provider Contact Information<\/a><\/p>\n<\/div><\/section><\/div>\n<div class=\"flex_column av_one_full  flex_column_div av-zero-column-padding first  avia-builder-el-3  el_after_av_one_full  avia-builder-el-last  column-top-margin\" style='border-radius:0px; ' id=\"billing\" ><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h4>Billing &amp; Financial Assistance Resources<\/h4>\n<h2><span style=\"color: #0184b0;\">Billing &amp; Collections<\/span><\/h2>\n<h3>Admission<\/h3>\n<p>Before the patient is admitted to the Hospital, the Admission\u2019s team will make reasonable efforts to collect a patient\u2019s insurance and other information and to verify coverage for the services to be provided. This information should be obtained prior to the delivery of non- emergent healthcare services.<\/p>\n<p>After the Admission team receives a referral, they will verify insurance and check benefits. We will be reviewing to ensure insurance coverage is active and whether a plan is in-network or out-of-network. To assist with the accuracy of the insurance verification, please provide a copy of the patient\u2019s insurance card(s), exact patient name, and date of birth.<\/p>\n<ul>\n<li>Each plan can vary on the level of coverage for inpatient rehabilitation including potential non-coverage for plans that are out-of-network.<\/li>\n<li>After benefits are verified, the Hospital Admission team will determine if an insurance authorization is required. If one is required, the Admissions team will start the authorization process for inpatient rehabilitation. This may take several days to receive a response from the insurance plan.<\/li>\n<\/ul>\n<h3>During and After the Patient\u2019s Hospital Stay<\/h3>\n<p>After an admission is approved, the patient will admit and sign applicable Admission forms. During a patient\u2019s stay, charges will be collected each day that include room and board, therapy, supplies, medications, labs, and other ancillary services performed.<\/p>\n<p>After the patient is discharged from the hospital, all charges are <a href=\"https:\/\/clearskyhealth.com\/lecanto\/about-us\/price-transparency\/\">summarized by service package and type of service<\/a>. These summarized charges are billed to the applicable third-party payer.<\/p>\n<p>The Central Business Office will bill all payers in accordance with contractual agreements and any applicable laws. After insurance payments have been settled and reflected on a patient\u2019s account, the patient will receive statements from the Hospital requesting payment on the patient balance. Patients may be required to pay non-emergent healthcare services in advance for services that will not be covered by third-party payers, including co-payments, deductibles, and co-insurance amounts.<\/p>\n<h3>Collections and Eligibility for Financial Assistance<\/h3>\n<p>Once a patient has been discharged and the patient\u2019s balance has been determined, the Central Business Office will initiate the patient statement series mailed each month in an attempt to collect the outstanding balances.<\/p>\n<p>Collections on patient balances will be pursued for a minimum of 120 days before any collection agencies will be engaged. Billing statements will include a notice regarding the Financial Assistance Policy, including information on how to obtain copies of the Financial Assistance Policy and a Financial Assistance Application.<\/p>\n<p>The Central Business Office will evaluate the Financial Assistance requests received to determine applicable discounts that can be applied to the patient\u2019s balances.<\/p>\n<ul>\n<li>The Central Business Office will consider a patient\u2019s total resources which would include, but are not limited to, an analysis of income and expenses. This would be done by having the patient complete a Financial Assessment Form and supply the necessary supporting documentation to make a determination of financial hardship.<\/li>\n<li>The Central Business Office must determine that no source other than the patient would be legally responsible for the patient\u2019s medical bill.<\/li>\n<li>The patient\u2019s file must contain documentation of the method by which indigence and hardship was determined including all the backup information substantiating the determination.<\/li>\n<\/ul>\n<p>In addition, the Central Business Office will evaluate and potentially approve payment plans for patients who have difficulty paying their full account balance at one time. These are evaluated on a case-by-case basis. If no payment arrangements have been made and the Central Business Office collection efforts have been exhausted, the account can then be sent to a collection agency.<\/p>\n<\/div><\/section><br \/>\n<div  id=\"policy\"   class='hr hr-default   avia-builder-el-5  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">Financial Assistance Policy<\/span><\/h2>\n<p>ClearSky Health has a Financial Assistance and Charity Care policy to assist individuals who may be un-insured or under-insured and would meet the medical necessity guidelines for an inpatient rehabilitation stay at our hospital.<\/p>\n<p>ClearSky Health will file all applicable insurance, Medicare, Medicaid, and other Third-Party Liability claims. If you qualify for any State or Local Funded Programs, please provide information regarding your application status. The financial assistance will apply to the patient balance after all insurances have been settled or to the private pay balance after the private pay discount.<\/p>\n<p>To apply for Financial Assistance, you may request an application when you are being evaluated by our clinical staff before admission. You may also print off the application <strong><a href=\"https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2023\/08\/FinancialHardshipApplication_Lecanto.pdf\" target=\"_blank\" rel=\"noopener\">from this link<\/a><\/strong>.<\/p>\n<p>Once you have completed and signed the application, it should be turned into our staff <a href=\"https:\/\/clearskyhealth.com\/lecanto\/billing-and-financial-assistance-resources\/#hardship\">per instructions<\/a>. This should be completed before your admission to the hospital; it is not a guarantee that your application will be approved.<\/p>\n<p>The application will be reviewed by our Central Business Office and will be either approved or denied based on the National Poverty Guidelines. The decision is based on the number of people in your household and the combined gross income of everyone in the household. Your portion of the patient\u2019s responsibility may be partially or fully discounted based on the guideline. Patients whose family income is equal to or less than 200% of the Federal Poverty Guideline are generally eligible for free care. Patients whose income is above 200% of the Federal Poverty Guidelines may be eligible for a sliding scale discount. The Central Business Office will have a decision made and communicated to you after the application has been received by them.<\/p>\n<p>This assistance does not apply to provider or physician fees. Please contact your practitioner directly to discuss their specific financial hardship processes. <strong><a href=\"https:\/\/clearskyhealth.com\/lecanto\/physician-and-provider-contact-information\/\">View Physician Listings Page<\/a><\/strong>.<\/p>\n<p>For questions regarding the financial assistance, you may contact the Central Business Office by <a href=\"mailto:bu************@cl************.com\" data-original-string=\"YkfGv2y5lfj8NJCuRBRu8A==79c2m2UJF6NXMIybV9jKGj8WnmOCwUoIEI\/8Y8KdOgZqb2kZMbzGwj01ueACv62IAfP\" title=\"This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\">email<\/a> or by calling us at <strong><a href=\"tel:505-317-3956\">505-317-3956<\/a><\/strong>.<\/p>\n<\/div><\/section><br \/>\n<div  id=\"guidelines\"   class='hr hr-default   avia-builder-el-7  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">Financial Assistance Discount Guidelines<\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4974 size-full\" src=\"https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale.png\" alt=\"\" width=\"1638\" height=\"587\" srcset=\"https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale.png 1638w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-300x108.png 300w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-1030x369.png 1030w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-768x275.png 768w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-1536x550.png 1536w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-1500x538.png 1500w, https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2025\/06\/2025-sliding-scale-705x253.png 705w\" sizes=\"auto, (max-width: 1638px) 100vw, 1638px\" \/><\/p>\n<\/div><\/section><br \/>\n<div  id=\"application\"   class='hr hr-default   avia-builder-el-9  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">Financial Hardship Application<\/span><\/h2>\n<p>A Financial Hardship Application must be completed to determine if you will qualify for financial assistance and charity care. The Financial Hardship Application must be filled out completely and all supporting documentation attached before a determination can be made regarding final financial status. <strong><a href=\"https:\/\/clearskyhealth.com\/lecanto\/wp-content\/uploads\/sites\/14\/2023\/08\/FinancialHardshipApplication_Lecanto.pdf\" target=\"_blank\" rel=\"noopener\">Click Here to View\/Download Application.<\/a><\/strong><\/p>\n<p>The Financial Hardship Application will be reviewed to determine the level of assistance that can be provided. This determination may help with all or a percentage of the patient balance if approved.<\/p>\n<p>ClearSky Health will file all insurance, Medicare, Medicaid and other Third-Party Liability claims. If you qualify for any State or Local Funded Programs, please provide information regarding your application status. The Charity Care request form is used as a last resource.<\/p>\n<p>The Financial Hardship Application will only be in effect for the dates of service that are currently being rendered. (Does not cover indefinitely).<\/p>\n<\/div><\/section><br \/>\n<div  id=\"hardship\"   class='hr hr-default   avia-builder-el-11  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">Financial Hardship Application Assistance<\/span><\/h2>\n<p>INSTRUCTIONS ON COMPLETING APPLICATION<br \/>\nPlease complete the application and attach supporting documentation.<br \/>\nApplication must be signed and dated by the patient requesting financial assistance.<\/p>\n<ol>\n<li><strong>Patient information:<\/strong> print patient name and fill out the address, responsibly party and how long at the address at the top of the form. Please include the number of people that live in the household, including children and other dependents.<\/li>\n<li><strong>Banking Information, Savings &amp; Investment\/Other Account Balance:<\/strong> List the total balances for checking, savings, or other investment accounts for all individuals in the household. Please include 401s, and other pension accounts.<\/li>\n<li><strong>Income:<\/strong> Include the income of everyone in the household. Please list the gross amount of each individual in the household. This does include Social Security Income, retirement income, child support and any other type of income that is received by anyone in the household.<\/li>\n<li><strong>Monthly Obligations:<\/strong> This portion of the application should include all expenses of the household and should only include the monthly payment amount that you pay for each outstanding expense that you have incurred.<\/li>\n<li><strong>Application must be signed and dated by the patient requesting charity care. <\/strong><\/li>\n<li><strong>Submit the application to the Finance Department.<\/strong> The Finance Department will review the application and use the Federal Poverty Guidelines to determine if the patient qualifies for any discount. This is based on the income and total number of people in the household.<\/li>\n<\/ol>\n<ul>\n<li>Please scan and email all documents to Central Business Office email: <a href=\"mailto:bu************@cl************.com\" data-original-string=\"jTGjXRxbK17MrDyfNIdmsg==79cH6JsJOc+Rh0OPLK4QusyLuKCujgzLjHwOebLZiapMjmsHOSF0v638\/vmIuTYQbdG\" title=\"This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\"><span \n                data-original-string=\"vvS\/UOwTuaKaxsOXT+7LnQ==79cxV0aL2N2ZfrBr57CTA0QwGItNVA7+BHu5RMNop+x4sSuKqwI2lb6k4iGE71KRcF8\"\n                class=\"apbct-email-encoder\"\n                title=\"This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\"><br \/>\n        <span class='apbct-ee-blur-group'><br \/>\n            <span class='apbct-ee-blur_email-text'>bu************@cl************.com<\/span><br \/>\n            <span class='apbct-ee-static-blur'><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-init'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-soft'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-hard'><\/span><br \/>\n            <\/span><br \/>\n            <span class='apbct-ee-animate-blur'><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-init apbct-ee-blur_animate-init'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-soft apbct-ee-blur_animate-soft'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-hard apbct-ee-blur_animate-hard'><\/span><br \/>\n            <\/span><br \/>\n        <\/span><br \/>\n<\/span><\/a> OR<\/li>\n<li>Mail a copy of the completed application and all documents to:<br \/>\n<strong>ClearSky Health<\/strong><br \/>\n<strong> ATTN: Business Office<\/strong><br \/>\n<strong> 5600 Wyoming Blvd. NE Suite 225<\/strong><br \/>\n<strong> Albuquerque, NM 87109<\/strong><\/li>\n<li>If you need additional assistance with the application, please call the Central Business Office at <a href=\"tel:505-317-3956\">505-317-3956<\/a>.<\/li>\n<\/ul>\n<\/div><\/section><br \/>\n<div  id=\"statement\"   class='hr hr-default   avia-builder-el-13  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">How to Request an Itemized Statement<\/span><\/h2>\n<p>An itemized statement or bill may be requested and will be provided within 7 business days after the request or the discharge date, whichever is later. The itemized bill or statement will contain details of the individual charges by date. Physician services will not be included in this bill. You should contact the physician who provided the service to obtain an itemized bill or statement for the service provided.<\/p>\n<p>Questions or concerns regarding your bill can be addressed by sending us an email to the email below or calling the number below:<\/p>\n<ul>\n<li>Central Business Office phone number: <a href=\"tel:505-317-3956\">505-317-3956<\/a><\/li>\n<li>Central Business Office email: <a href=\"mailto:bu************@cl************.com\" data-original-string=\"GDnXXExMwEri11DeEmNUnw==79cL8n60XR\/5VdU\/PSlM9UzLq\/6shxZSVMkFoEPTaSej7DL2C43xO3KgtQRNNk1J71u\" title=\"This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\"><span \n                data-original-string=\"WW4CtUJUVFDAWIytJnzeHw==79cYiOKhW3H1a\/Y4oqUw22nz1kPegzzgp3fdMh1a3GbN3VQbscK\/VX33goKRDFCBEit\"\n                class=\"apbct-email-encoder\"\n                title=\"This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\"><br \/>\n        <span class='apbct-ee-blur-group'><br \/>\n            <span class='apbct-ee-blur_email-text'>bu************@cl************.com<\/span><br \/>\n            <span class='apbct-ee-static-blur'><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-init'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-soft'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-hard'><\/span><br \/>\n            <\/span><br \/>\n            <span class='apbct-ee-animate-blur'><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-init apbct-ee-blur_animate-init'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-soft apbct-ee-blur_animate-soft'><\/span><br \/>\n                <span class='apbct-ee-blur apbct-ee-blur_rectangle-hard apbct-ee-blur_animate-hard'><\/span><br \/>\n            <\/span><br \/>\n        <\/span><br \/>\n<\/span><\/a><\/li>\n<\/ul>\n<p>If you are not fully satisfied with the resolution to your questions or concerns, you may contact the Florida Agency for Health Care Administration directly at 888-419-3456 or 800-955-8771.<\/p>\n<\/div><\/section><br \/>\n<div  id=\"contact\"   class='hr hr-default   avia-builder-el-15  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h2><span style=\"color: #0184b0;\">Physician &amp; Provider Contact Information<\/span><\/h2>\n<p>Provided are the applicable names, mailing addresses, and telephone numbers of the health care practitioners and medical practice groups with which we contracted to provide services in our rehabilitation hospital. Please reach out to the providers for the below questions:<\/p>\n<ul>\n<li>To request a current physician or provider itemized statement<\/li>\n<li>To request a personalized estimate of reasonably anticipated practitioner or group charges for your specific condition.<\/li>\n<li>To contact the practitioners or groups to determine which health insurers and health maintenance organizations they participate in as network providers or preferred providers.<\/li>\n<\/ul>\n<p>This listing is updated quarterly. Practitioners may be added or removed during this time. For questions or concerns, please call the hospital directly and ask to speak with Credentialing, so that we can assist you with the most current information.<\/p>\n<p><strong><a href=\"https:\/\/clearskyhealth.com\/lecanto\/physician-and-provider-contact-information\/\">Click Here to view Physician &amp; Provider Contact Information<\/a><\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-4491","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Billing and Financial Assistance Resources - 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