Lawrenceville Surgery Center participates in a program to help patients with their surgery bills.  If you qualify, the entire bill will be written off toward our Indigent Care Fund.

How do I Qualify?  To qualify you will need to provide proof of income for ALL MEMBERS OF YOUR HOUSEHOLD and TOTAL ANNUAL FAMILY INCOME.  Once this information is obtained it is compared to the Federal Poverty Guidelines for your family size which are listed below:

 Family Size    Income Range
1 $9,750-$23,925
2 $12,830-32,075
3 $16,090-$40,225
4 $19,350-$48,375
5 $22,610-$56,525

(If your family falls within the income range for the number of family members, you may qualify)

What if I do not fall within the Income Range?  If you do not fall within the income range for your family size, you will need to supply additional documentation.  Please provide current receipts for the following household expenses:  phone bill, water bill, gas bill, rent receipts, car payment, credit card statements, and insurance receipts.  We will compare them to your income to determine your debt to income ratio which will show your qualification.

How do I apply for this program?  Simply complete the Qualification Form (see below) and provide documentation of income (last 2 paycheck stubs, W-2 forms, bank statements).

• Financial Assistance Qualification Form
• Written Statment

What if I am unemployed or did not file taxes last year?  Complete the Written Statement and return it with the Qualification Form.

Where do I send the information?  Return the Qualification Form, Written Statement, or income documentation to Lynda Rexroat, Administrator.

Mail or deliver to:
    Lawrenceville Surgery Center
    Attn:  Lynda Rexroat
    758 Old Norcross Road # 125
    Lawrenceville, GA  30046

Fax to :   (678) 987-0821

Questions?  Contact Lynda at (678) 987-0820 or email Lrexroat@uspi.com