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Sentara financial assistance

Sentara financial assistance 2025

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The document is an application for financial assistance from Sentara Hospitals, designed to help patients who may be eligible for reduced healthcare costs based on their income. It includes sections for patient information, household details, assets, liabilities, and additional resources. The document emphasizes the hospital's commitment to supporting patients with unplanned healthcare expenses and provides contact information for further assistance.

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Click ‘Get Form’ to open the Sentara Financial Assistance application in the editor.
Begin by entering the Patient Name and Account Number at the top of the form. Ensure that all details are accurate for proper processing.
Fill in the Patient Address, Phone Number, Admit Date, and Discharge Date. This information is crucial for identifying your case.
In the Charges section, input Total Charges and Write Off Amount. This helps assess your financial needs.
List every member of the patient’s household along with their age and relationship to the patient. Use additional sheets if necessary.
Complete the Assets, Liabilities, Income, and Expenses section by indicating whether you own or rent your home and providing relevant financial details.
Review all sections for accuracy before signing and dating the application at the bottom. Your signature authorizes Sentara Hospitals to verify your information.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (106 Votes)
2016	4.4 Satisfied (96 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the Uninsured Patient Discount Program for sentara?

Sentara Uninsured Patient Discount Program If you do not have health insurance and you do not qualify for assistance under the financial assistance policy above, you may be eligible for the Sentara Uninsured Discount Program. An administrative adjustment equal to 50% of Hospital Facility Gross Charges is available.

Does Sentara offer a pension plan?

Pension Plan Basics Sentara pays the full cost of your Plan benefit you make no contributions. You become fully vested in your benefits once you have completed five years of vesting service. Participation requires a minimum of 5 years of service, working at least 832 hours in each year.

What is the minimal financial assistance?

What is Minimal Financial Assistance subsidy? The Subsidy Control Act 2022 provides for a mechanism called Minimal Financial Assistance (MFA) to allow authorities to provide grants that are considered small enough to support individual business without giving them an unfair advantage.

Does Sentara offer OTC benefits?

Your Sentara Medicare plan can help keep more money in your pocket when you take advantage of your OTC quarterly allowance. Purchase a wide selection of non-prescription drugs, supplies, and healthcare products through the plans catalog of items.

Do hospitals allow payment plans?

Many medical providers, including physicians, dentists and hospitals, can work out a no- or low-interest payment plan for your medical bills. This is one of the simplest and most common ways to resolve a bill you cant afford in one payment.

sentara financial assistance form

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What is need based financial assistance?

The term need-based is a designation that is based on a students financial need. For example, a need-based grant might be awarded based on a students low income. Was this page helpful? When will I receive my financial aid?

Does Sentara offer payment plans?

With Sentara Bill Pay, you can choose to manage your balance by paying in full or setting up a new payment plan that meets your needs. In addition, youll be able to: Consolidate and manage your familys hospital and physician bills in one place.