Financial Assistance

Pay My Bill Online

John D. Archbold Memorial Hospital, Inc. ("Archbold") offers two Financial Assistance Programs for uninsured and indigent patients that are applicable to the following hospitals and clinics: Archbold Memorial, Archbold Grady, Archbold Mitchell, Archbold Brooks hospitals, Archbold Primary Care—Camilla, Archbold Primary Care—Pelham and Archbold Pediatrics—Camilla. An uninsured patient is someone who has no health coverage at all, and who does not have any right to be reimbursed for healthcare expenses by someone else. A patient who has health coverage is considered uninsured if the patient has a claim denied based on a pre-existing condition, having reached benefit maximums, or that a particular service is not covered. For purposes of financial assistance offered by Archbold, a person with an annual household income below 200% of the Federal Poverty Line is considered indigent, regardless of whether that person has healthcare coverage.

The purpose of this Plain Language Summary is to provide general information for the two Financial Assistance Programs offered by Archbold. Please refer to the complete policies entitled “Financial Assistance Program – Indigent Care Trust Fund” and “Financial Assistance Program – Uninsured Patients” for further details.

Click here for the complete Financial Assistance Program – Plain Language Summary Policy

Program #1: The Indigent Care Trust Fund (“ICTF”) Financial Assistance Program

If you are indigent or uninsured with an annual household income of less than 200% of the Federal Poverty Level (please see box below), you will qualify for the ICTF Financial Assistance Program provided that you (1) are a resident of the State of Georgia; (2) complete the application for Financial Assistance; and (3) apply for Medicaid, Medicare or Medicare Disability, if requested. If you are eligible for the ICTF Financial Assistance Program, you will receive a complete write-off of all charges for services.

• Click here for the complete Financial Assistance Program – Indigent Care Trust Fund Policy
• Scroll to the bottom of this page to fill out the Financial Assistance Program Application electronically.
• Click here to print the Financial Assistance Program Application.

You have a right to:

• The availability of free and reduced-charge services
• The ability to gain admittance without pre-admission deposits
• Not be transferred solely or in significant part for economic reasons
• The availability of services provided
• The terms of eligibility for free and reduced services
• The application process free and reduced charges
• The person or office to which complaints or questions about the hospital’s participation in or operation of the program may be directed

Program #2: The Financial Assistance Program for Uninsured Patients

If you are an uninsured patient who lives in Brooks, Grady, Mitchell, or Thomas County, Georgia, or in a county in Georgia that does not have a hospital offering the services you require, and your annual household income falls between 200% and 325% of the Federal Poverty Level (please see box below), you may be eligible for a discount for medical services.

To be eligible, you must: (1) submit an application for assistance within 240 days from the date the patient account is billed; (2) apply for commercial or government insurance coverage if requested; (3) have personal and business assets, excluding your personal residence, totaling less than $50,000.00; and (4) comply with an interest-free payment plan following a determination of your qualification for assistance.

If you are found by Archbold to be qualified for assistance under the Financial Assistance Program for Uninsured Patients, you will be charged no more than "amounts generally billed," which is based on the average of the amounts actually paid to the hospital facility by private health insurers and Medicare, including co-payments and deductibles, for the medically necessary or emergency services that you receive.

• Click here for the complete Financial Assistance Program – Uninsured Patients Policy
• Scroll to the bottom of this page to fill out the Financial Assistance Program Application electronically.
• Click here to print the Financial Assistance Program Application.

A free copy of Archbold's financial assistance policies and the application forms for financial assistance may be obtained by downloading them from Archbold's website (www.archbold.org). Free copies are also available at each hospital facility in the admissions or registrations areas. You may also call 229.228.8870, Account Management Services, to request that a free copy of the policies and application forms be mailed to you.

Archbold staff located in the admissions and registration areas are available to provide information about the Financial Assistance Programs as well to help you complete the application process. You may also reach the appropriate staff to obtain this information or assistance by calling 229.228.8870 or 229.228.8840.

To help you determine which program to apply for we have provided the current poverty guidelines as determined by the Department of Health and Human Services:

2023 Federal Poverty Guidelines

Number of Persons in Household Federal Income Poverty Guidelines

1. $14,580
2. $19,720
3. $24,860
4. $30,000
5. $35,140
6. $40,280
7. $45,420
8. * $50,560

*For families/households with more than 8 persons, add $5,140 for each additional person.

Help with your hospital bills

In order to determine if you are eligible for financial help with your bills for inpatient and outpatient services, please complete our Financial Assistance Application. For questions contact our Case Manager at 229.228.8840 or 1-877.269.8181, ext. 8840. You may also FAX your questions to 229.584.5906. Archbold's Patient Financial Services is located at 920 Cairo Rd., Thomasville, Georgia.

If you have problems:

If you have any concerns about how we operate programs under the Indigent Care Trust Fund rules, please let us try to work with you to resolve them. You may reach Archbold’s Patient Financial Services management at 229.228.8861. Your call will be returned within three business days. However, if you are not satisfied with our handling of your situation, you may call the Department of Community Health toll-free at 1.877.261.3117 or write to:

Indigent Care Trust Fund
Medical Policy Unit, Hospital Services
Division of Medicaid
2 Peachtree Street, NW, 37th Floor
Atlanta, GA 30303-3159

Click Here for All Financial Assistance Policies

How to Apply for Financial Assistance

As your community healthcare provider, Archbold provides the Financial Assistance Program to assist eligible uninsured and/or underinsured patients and their families with medical bills beyond their ability to pay. You may apply in person at the time of service, at the Patient Financial Services office, scroll to the bottom of this page to fill out the Financial Assistance Program application electronically or click here to print the Financial Assistance Program application. Complete the application form and worksheet and return to: Archbold Medical Center, P.O. Box 915, Thomasville, GA 31799.

How do I know if I am eligible for the Financial Assistance Program?

To apply for this program, you must complete the Financial Assistance Program application form, sign and return it to our Patient Financial Services office. We use your information about your family size and income to help determine eligibility. The information provided will remain confidential and will be used only to determine your eligibility for financial assistance.

How do I know if I have been approved for the Financial Assistance Program?

The Financial Assistance Program Case Manager will review your application and determine your eligibility. You will be notified by mail regarding your eligibility and the amount of charges covered under the program if your application is approved. If an Archbold financial assistance discount is awarded, you will be subject to an interest-free monthly payment plan established by the balance of your accounts after all discounts are applied.

What if I have questions about my application or eligibility?

Please feel free to call our Financial Assistance Program Case Manager at 229.228.8840 or toll-free at 1.877.269.8181, ext. 8840. You may also fax your questions to 229.584.5906. Archbold's Patient Financial Services is conveniently located at 920 Cairo Rd., Thomasville, Georgia.

Directions to Patient Financial Services