Public Disclosure of Financial Assistance
Adventist HealthCare is committed to meeting the health care needs of our community through the ministry of physical, mental and spiritual healing. All patients, regardless of race, creed, sex, age, national origin or financial status, may apply for financial assistance.
Availability of Financial Assistance
You may be able to get financial assistance if you do not have insurance, are underinsured, or if it would be a financial hardship to pay in full your expected out-of-pocket expenses for emergency and other medically necessary care that Adventist HealthCare provides.
How to Apply for Financial Assistance
Follow these three steps to apply for financial assistance:
1) Check Your Eligibility
Adventist HealthCare provides financial assistance based upon need. To determine need, we review your household income and compare it to the Federal Poverty Level Guidelines set by the U.S. Department of Health and Human Services. We also review the amount of charges for which you are responsible.
If you and/or the party responsible for payment has combined income equal to or below 200 percent of the federal poverty guidelines, you will have no financial responsibility for the care that Adventist HealthCare provides. If you fall between 200 percent and 600 percent of the guidelines, you may qualify for discounted rates for our care.
If you are eligible for financial assistance under this policy, Adventist HealthCare will not charge more for your emergency or other medically necessary care than the amounts we generally bill to individuals who have insurance for such care. In certain cases, we may presume you are eligible for financial assistance if you already qualify for certain types of governmental aid.
You may be ineligible for financial assistance if you have sufficient insurance coverage or we determine your income is enough to pay for care. Please see the links below for our full policy, which provides more explanation and details.
2) Download & Complete Application
If you need help with the application form or have further questions, please call Patient Financial Services at 301-315-3660 or visit our offices located at:
Shady Grove Medical Center
9901 Medical Center Drive
Rockville, MD 20850
White Oak Medical Center
11890 Healing Way
Silver Spring, MD 20904
3) Submit Your Application
Mail (or drop off) your completed application with required documentation to:
Patient Financial Services Department, 5th Floor
810 W Diamond Avenue
Gaithersburg, MD 20878
Providers on Staff
The following physicians and mid-level providers (en Español) have privileges at one or more of Adventist HealthCare’s hospitals and are NOT covered under this policy.
Physician practices may offer their own financial assistance plans, so we encourage you to speak directly with your doctor about programs that may be available to help with charges related to your care.
Translation Services Available
The Financial Assistance Policy, application form and this plain language summary is available in English or Spanish. Adventist HealthCare can provide assistance through a qualified bilingual interpreter upon request.