Payment Plans and Financial Assistance
It is always beneficial to contact your insurance company to determine what your benefit plan is. It is the responsibility of the policy holder to know their deductible, co-insurance and co-payments. We will collect the applicable deductible, co-payment or co-insurance amount at the time of service. If you are unable to pay your account in full, a payment plan may be available to you.
To set up a payment plan, please contact one of the numbers below:
|Patient Accounts||Pediatric Physician Services||West Coast Neonatology||OB/GYN Specialists|
ACH is committed to providing financial assistance to persons who have health care needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay, for medically necessary care based on their individual financial situation.
If you are unable to pay for necessary medical care, you may qualify for financial assistance based on the criteria listed below.
- Have applied for Medical Assistance and do not meet eligibility requirements.
- The patient must be a United States of America citizens or permanent resident (must have resided in the U.S.A. for a minimum of one year).
- The patient/family must have been a resident of the state of Florida for the past six (6) months.
- Have exhausted all insurance options.
- Complete Financial Assistance Application and provide all required documentation.
- Meet the financial guidelines based upon your income, assets and outstanding debt.
To determine if you are eligible for financial assistance, please fill out the following forms:
- Financial Assistance Application (PDF)
- Financial Assistance Application Spanish (PDF)
- Patient Profile Questionnaire (PDF)
- Patient Profile Questionnaire Spanish (PDF)
- Medical Financial Hardship Application (PDF)
Submit completed Applications and the Patient Profile Questionnaire to the following location:
All Children's Hospital
501 6th Avenue South, D#9050
St. Petersburg, FL 33701
If you have questions, please call the Business Office at 727-767-4410.