Financial Assistance Program
Tennova Healthcare - Clarksville is committed to treating all patients regardless of their ability to pay and to providing financial assistance to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for their medical care based on their individual financial situation under our hospital's Financial Assistance Program. No patient will be denied financial assistance due to his or her race, religion, national origin or any other basis prohibited by law.
We provide eligibility screening services that can help identify the availability of community or government-sponsored programs for financial assistance to cover medical services, such as Medicaid. However, even if a patient does not qualify for state or federal assistance, financial relief may be available to patients who receive non-elective care and are unable to pay a substantial portion of their balance, either directly or through insurance under our Financial Assistance Program.
FINANCIAL ASSISTANCE ELIGIBILITY. We offer a Charity Care Discount on a sliding scale under our Financial Assistance Program to patients who qualify under our policy, based on the patient's adjusted gross income (or patient's household if filing taxes jointly) for the current year or prior year compared to the U.S. Federal Poverty Guidelines, which will be evaluated using certain financial criteria and supporting documentation to verify income provided by the patient. Click here to download a copy of the U.S. Federal Poverty Guidelines.
Patients who do not qualify for our Charity Care Discount may still be eligible for financial relief under the hospital's Financial Assistance Program. Patients without insurance, who are not eligible for government assistance or our hospital's Charity Care Discount, will receive a partial discount from the hospital's billed charges, referred to as the "Uninsured Discount." Additionally, a patient may also be eligible for a "Catastrophic Care Discount," in the event the patient's account exceeds a certain percentage of the patient's gross annual income. For more information about the Discounts described above, please see the Financial Assistance Policy linked below (Exhibit D to the Financial Assistance Policy) for applicable guidelines.
AMOUNTS GENERALLY BILLED. For emergency or other medically necessary care, an eligible patient may not be charged more than amounts generally billed to individuals with insurance. The AGB is determined using the look-back method, as those methods are defined in federal tax law. For more information on Tennova Healthcare Clarksville's 2022 AGB percentage and calculation, please click here.
HOW DO I APPLY? A patient may apply for the Charity Care Discount by filling out our Financial Assistance Program ("FAP") Application and returning it to the hospital, along with any required documentation, at the time of service or any time after care is provided during the patient's billing cycle.
If a patient has any questions about Tennova Healthcare – Clarksville's Financial Assistance Policy and/or wishes to apply for financial assistance, please contact the hospital's Customer Service, Patient Access Director or Financial Counselor at (931) 502-1965 or (931) 502-1964. You may request a copy of the Financial Assistance Program Application free of charge at the above number, in person, or by downloading a copy from our website.
Financial Assistance Application
Click here to download a Financial Assistance Program Application (English)
Click here to download a Financial Assistance Program Application (Spanish)
Policies
Click here to view our Financial Assistance Policy (English)
Click here to view our Financial Assistance Policy (Spanish)
Plain Language Summary
Click here to view the Plain Language Summary of our Financial Assistance Program (English)
Click here to view the Plain Language Summary of our Financial Assistance Program (Spanish)