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Financial assistance policy and application

Summary of Financial Assistance Policy

For UCF Lake Nona Hospital

As part of our mission, UCF Lake Nona Hospital provides care to patients without financial means to pay for hospital services. Care will be provided to all patients who present themselves for care at UCF Lake Nona Hospital without regard to race, creed, color or national origin and who are classified as financially or medically indigent.

A financially indigent person is one who is uninsured or underinsured and is accepted for care with no obligation or discounted obligation to pay for services based on income and family size. The hospital uses poverty income guidelines issued by the U.S. Department of Health and Human Services to determine a person's eligibility for charity care.

A medically indigent patient is a person whose medical and hospital bills after payment by third party payers exceeds 1O percent of the person's annual gross income and the person is unable to pay the remaining bill. UCF Lake Nona Hospital may consider other financial assets and liabilities of the patient when determining ability to pay.

Financial assistance with respect to emergency and medically necessary care may be available to patients who do not qualify for state or federal assistance. In most cases, patients that fall below 200 percent of the federal poverty guidelines based on total household income may receive 100 percent of their bill forgiven (subject to income verification/documentation requirements). In certain cases, other discounts ranging from 40 to 90 percent apply if the patient's total household income is over 200 percent and not more than 500 percent of the federal poverty guidelines.

Financial assistance may be available to insured patients who have received emergency services only. If the patient’s total household income is over 200 percent of the federal poverty guidelines, their balance will be capped to a fixed amount based on the patient’s income, federal poverty guidelines, and the type(s) of emergency service(s) received.

Further eligibility and assistance information, a copy of our financial assistance policy, the financial assistance application form, a plain language summary of the financial assistance policy and a listing of physicians who provide emergency or other medically necessary services at UCF Lake Nona Hospital, including whether their services are covered under the financial assistance plan, are available by clicking the links below or by written request to the following address:

Shared Services Center
PO Box 290669
Nashville, TN 37229-0669

Download Financial Assistance Policy and Application

Financial Assistance Policy in English

Política de Ayuda Financiera

Política de Asistencia Financiera

Financial Assistance Application

Solicitud de Asistencia Financiera

Physicians Providing Emergency and Medically Necessary Care

You may apply for financial assistance by completing the application referenced above and submitting it at the address above.

If you are eligible for financial assistance, the amount charged for emergency or other medically necessary care will not exceed amounts generally billed to patients with insurance. Patients may request information on this calculation by submitting a request to the address listed below:

Additional information concerning UCF Lake Nona Hospital's financial assistance program and how to apply for financial assistance can be obtained from the business office at:

Shared Services Center
PO Box 290669
Nashville, TN 37229-0669

Or, you may call the location at: