Insurance Financial Assistance Policy
At Axis Spine and Sport in Gilbert AZ and Tempe AZ, we believe that access to medically necessary care should not be denied due to financial limitations. In accordance with federal law and applicable insurance contract compliance, our practice offers a formal Financial Indigency Policy to provide discounted services for qualified out-of-network patients who are experiencing financial hardship or have high-cost health plans.
This policy is compliant with applicable healthcare regulations, including ERISA, PPACA, and federal and state commercial insurance laws, and is modeled similarly to prompt-pay and hardship-based discount programs used by major carriers and hospital systems.
Eligibility Requirements
To qualify for financial assistance under this policy, all of the following conditions must be met:
- You are a patient of Axis Spine and Sport, which is a 100% out-of-network healthcare provider.
- You have private commercial insurance with an individual deductible of $1,500 or greater OR you are unable to pay due to verifiable financial hardship.
- You are not enrolled in any of the following programs:
- Medicare
- Medicaid (AHCCCS)
- TriWest or other VA-based coverage
- Any state or federally funded healthcare plans
Important: If you have Medicare, Medicaid, or TriWest, we are unable to legally provide services, even on a cash-pay basis, due to federal billing regulations. We will assist in referring you to another eligible provider.
Discount Structure (Estimated Guidelines)
Axis Spine and Sport offers prompt-pay discounts of up to 25% off standard fees, as well as income-based discounts under our Indigency Program.
| Less than $50,000/year | Up to 75–100% off | With limited savings or fixed income |
| $50,000–$75,000/year | Up to 50–75% off | Must show moderate burden from deductible or copay |
| $75,000–$105,000/year | Up to 25–50% off | Applies if high-deductible or recent financial strain |
| $105,000+/year with $1,500+ deductible | Up to 25% off | Prompt-pay discount only |
These ranges are flexible and determined based on:
- Your insurance benefits and deductible structure
- Your monthly income and expenses
- Any recent financial challenges (e.g., job loss, medical bills, caregiving, etc.)
Required Documentation
In most cases, patients may self-attest to financial hardship using a simple declaration form. However, upon request, the following documentation may be required:
- Most recent pay stub
- Prior year tax return
- Bank statement or record of major expenses
- Proof of high medical bills, loss of income, or other hardship-related documents
We reserve the right to request documentation if the discount exceeds standard prompt-pay limits or is needed for compliance purposes.
How the Process Works
- Request a Discount
- At or before your first visit, notify our staff that you are requesting financial assistance or a payment discount under this policy.
- Complete an Indigency Form
- You’ll complete our Financial Indigency & Payment Agreement Form (available in-office or online) and attest to your hardship or high-deductible status.
- Review & Approval
- Your request will be reviewed by our management team. If approved, you’ll receive an adjusted rate, payment plan option, or prompt-pay offer based on your individual situation.
- Claim Handling
- Your insurance will be billed at the full out-of-network rate, but we will not collect the full balance from you until the claim is fully adjudicated.
- You will not be held liable for any balance beyond your disclosed ability to pay, so long as your hardship is documented in accordance with federal protections under ERISA and PPACA.
Payment Plan Option
If you do not qualify for a discount but still need help managing your balance, we offer no-interest payment plans based on the following:
- Flexible terms (monthly or per-visit)
- Up to 6–12 months duration
- No penalty for early payoff
Legal Disclosures
- No discount under this policy shall be granted in exchange for volume, referrals, or future services.
- Axis Spine and Sport will not waive patient financial responsibility routinely, only after case-by-case evaluation and documentation of hardship or high-cost plan structure.
- All discounts comply with applicable ERISA, PPACA, and state laws and are not applicable to patients with government-funded healthcare plans.
“Nothing in the Centers for Medicare & Medicaid Services (CMS) regulations, Provider Reimbursement Manual, or Program Instructions prohibits a healthcare provider from waiving collection of charges to any patients, including low-income, uninsured or medically indigent individuals, if it is done as part of the healthcare provider’s Indigency Policy.”
Request Assistance
To request a hardship discount, please speak with our front desk or billing team at your visit, or contact us directly: billing@axisspineandsport.com
