Mid-South Pulmonary Specialists, P.C. was formed for the purpose of treating patients with pulmonary disorders. Mid-South Pulmonary Specialists, P.C. is a for profit professional corporation and as such patients are expected to pay for treatment at the time of service. However, there are patients who are unable to pay the cost of their medical bills for various reasons. In order to assist our patients with pulmonary disorders who are unable to pay, an indigent program was developed.
Patients interested in the program must ask for the application for the program from the receptionist. The patient must then fill out the form completely and provide proof of indigence in the form of copies of the past two year’s Income Tax Returns and the last six months of bank statements. If the patient has never worked, he/she must provide a notarized copy of his financial situation from a recognized government agency (e.g. pay stubs for a month period). Once the patient has filled out the form, signed, and attached proof of indigence, the form is to be returned to Mid-South Pulmonary Specialists, P.C. to the attention of the Practice Manager. Upon receipt of a completed application and all required supporting documentation, Mid-South Pulmonary Specialists, P.C. will use the 2009 Poverty Guidelines from the Department of Health and Human Services. MSPS uses 250% of the poverty guidelines in determining indigent status. The patient will be notified if he/she qualifies for the program.
If a patient meets the guidelines, his account will be written off from the point the patient met the guidelines and the patient will owe no monies. If a patient does not meet the guidelines, payment is expected either in full or in the form of monthly payments as set by the patient and a member of the billing department. All applicants’ financial information used to apply for the indigent program will be kept confidential and only used for the purpose of establishing indigent status.
Indigent status is good for one year. At the expiration, the patient must submit updated financial information to show no change in status. Failure to provide the updated information will cause the patient to lose indigent status.
Mid-South Pulmonary Specialists, P.C. does not discriminate upon the basis of race, gender, national origin, or religion. Acceptance into the program is based solely upon the patient’s providing all verifying documentation requested and then meeting the guidelines provided.
Please return all paperwork to the following address:
Mid-South Pulmonary Specialists, P.C.
5050 Poplar Ave.
Suite 800
Memphis, TN 38157
Attn: Indigent Program
Pulmonary and Critical Care Medicine Consultants
