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Financial Assistance Policy


Click On The Link To Download The Policy (English) In PDF Format
Financial Assitance Policy (English)

Click On The Link To Download The Policy (Spanish) In PDF Format
Política (Espanol)

Click On The Link To Download The Policy Summary (English) In PDF Format
Summary (English)

Click On The Link To Download The Policy Summary (Spanish) In PDF Format
Resumen (Español)

Click On The Link To Download The Application (English) In PDF Format
Application (English)

Click On The Link To Download The Application (Spanish) In PDF Format
Solicitud (Espanol)

Click On The Link To Download Free or Reduced Charge Services (English) In PDF Format
Application (English)

Click On The Link To Download Free or Reduced Charge Services (Spanish) In PDF Format
Solicitud (Espanol)

Transparency Disclosure


In compliance with the Centers for Medicare and Medicaid Services (CMS), Jeff Davis Hospital is providing a Charge Master to our charge master price lists. This does not account for negotiated insurance discounts, co-pays, co-insurance, deductibles and self-pay discounts. These prices do not always reflect all costs associated with a service. Per CMS guidelines, the file will be updated annually each July.

If you would like more information on this charge master, what your care will cost you, or the hospital's financial assistance policy, please contact our financial services department at number below:
912-375-7781 option 2

You may also consult with your insurance provider to understand what charges are covered, your co-pay, co-insurance, and deductible amounts or other out of pocket expenses.

Here is a partial list of health care providers who may bill you separately and whose charges are not included with the hospital:
Any physician involved in your care
The Surgeon who performs procedure
The radiologist who reads the x-rays or images
The pathologist who examines specimens, if applicable
Other physician who may be consulted by your doctor during
your time in the Hospital




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