Financial Assistance Programs Offered by Leigh Orthopedic Surgery Center, LLC

Purpose

This Financial Assistance Policy (“Policy”) establishes the policy to be followed by Leigh Orthopedic Surgery Center, LLC in: (1) determining the eligibility for Financial Assistance for those patients receiving Medically Necessary Services; (2) calculating amounts charged to a patient eligible for Financial Assistance; and (3) facilitating the patient application process for Financial Assistance. In addition, this Policy outlines Leigh Orthopedic Surgery Center, LLC’s billing and collections practices for medical care services provided at its Facility, including the efforts that Leigh Orthopedic Surgery Center, LLC will make to determine a patient’s eligibility for Financial Assistance prior to engaging in Extraordinary Collection Actions in the event of non-payment.

Methods for Applying for or Obtaining Financial Assistance

The Application for Financial Assistance is available at the patient registration area of the Facility and may also be downloaded from the link below. The Application for Financial Assistance may also be mailed free-of-charge to patients upon request by phoning the surgery center, or by sending a written request to the following address:

Leigh Orthopedic Surgery Center, LLC
Attn: Business Office Manager
6201 E. Virginia Beach Blvd, Suite 200
Norfolk, Virginia 23502

Completed Applications for Financial Assistance, along with proof of Household Income, should be mailed to the address set forth in this Policy. Alternatively, a patient may return a completed application, along with proof of Household Income, to the patient registration area of the Facility.

Patients who need additional information about this Policy, or who need assistance with the Financial Assistance application process, may visit the above location Monday through Friday during normal business hours to speak with the Business Office Manager.

Financial Assistance Information is Available in the Languages Below

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