1500 S.W. 10th Ave.
Topeka, Kan. 66604-1353
(785) 354-1150 or
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Financial Assistance Program
Stormont-Vail HealthCare has set up a Financial Assistance Program (FAP) for our patients who are financially unable to pay their bill in full. A FAP eligible individual will not be charged more for emergency or other medically necessary care than the amounts generally billed to individuals who have insurance covering such care.
Patients Who are Eligible for Financial Assistance Must Meet the Following Criteria:
- Patients who receive non-elective emergency and other medically necessary services. The following services are excluded from financial assistance: childhood vaccines (except those covered under the VFC program), adult vaccines other than flu, tetanus, Pneumovax, well patient exams, weight loss related exams, cosmetic procedures, drugs covered under a drug rebate program, drugs provided for non-emergent services, durable medical equipment, home visits, contraceptive drugs and devices, screening services, form completion, lifeline services, no show services, medical testimony fees, FAA exams, DOT exams, Pre-employment exams, fertility testing, genetic testing and other services not considered conditionally approved. Unless services are required to treat or diagnose a condition that poses life or limb threatening consequences to the patient.
- Must be a U.S. citizen.
- Must be a Kansas resident the last six months.
- If referred to Hospital Assistance Program and cooperated in seeking alternative resources for payment.
- Cooperated with your insurance carrier and provided insurance information before timely filing requirements had expired.
- Received payment directly from your insurance carrier and applied the insurance payment to your account.
- Do not have a court-ordered judgment to satisfy your account balance.
- Services were not the result of illegal activity.
Click here for a copy of the Financial Assistance Policy.
How to Apply for Financial Assistance
Individuals can apply for financial assistance by doing one of the following:
- Obtaining a paper financial assistance application form (with instructions on how to complete the form and the required documentation needed to submit) free of charge. Visit the hospital or clinic patient registration area to pick up an application, or call Customer Service at (785) 354-1150 to have an application mailed to you.
- Download and print a financial assistance application.
Application Instructions | Financial Assistance Application
- Request a financial assistance application form from a collection agency if your account has been turned over to collections due to non-payment.
Customer Service Representatives will be available to assist individuals with questions on how to complete financial assistance applications.
Once a patient has requested a FAP application from either Stormont-Vail HealthCare or the outside collection agency, and if within 240 days from the patient’s first statement, all Extraordinary Collection Activity (ECA) efforts, which includes legal action and reporting to credit agencies, will be stopped until the application is reviewed and determined approved or denied.
For amounts owed after the financial assistance discounts, we offer other options to pay your bill.
We Offer Payment Options to Pay Your Bill
For your convenience we accept a variety of payment methods that can be made online or by calling our customer service to pay:
- Electronic funds transfer
- Cash, check or money order
- American Express
Short-term payment plans or a bank loan may be available for larger balances. Any payment plan other than payments in full must be agreed to by our office before being accepted. Non-payment on balances due will result in your account(s) going to an outside collection agency, including, but not limited to, any extraordinary collection activity.
We hope this information has been helpful for you. To learn more about financial assistance, or if you have any questions about the Stormont-Vail HealthCare’s Financial Assistance Program, please contact a Customer Service Representative at (785) 354-1150 or (800) 637-4716, or by email at: firstname.lastname@example.org.