Patient Financial Responsibility

• Patients are never turned away from St. Jude because of their inability to pay.  
• All patients accepted for St. Jude treatment receive care whether or not they or their families can pay for it.  
• You will never have to pay for services authorized by St. Jude. These include services provided outside St. Jude that are approved by an authorized St. Jude care provider. 

St. Jude does have a billing system, but you will not get a bill. If the patient has insurance, St. Jude bills the insurance plan or other agency that pays health costs. St. Jude bills insurance for the costs that would be due at any other hospital. This allows us to continue doing some of the most advanced research in the world. It also allows us to cover:  

• Treatments 
• Copayments 
• Deductibles 
• Coinsurance 
• Any other costs that insurance does not cover 

If the patient is a patient of a St. Jude Affiliate, you should not be asked to pay for St. Jude Affiliate services that are directly related to the reason your child was accepted. St. Jude pays the affiliate for your copayment, deductible, or coinsurance. If you have no insurance, the affiliate may require you to apply for a federal or state insurance program to receive care at the affiliate. If so, St. Jude staff or the affiliate staff will help you. The St. Jude affiliate may also be paid by your insurance company but will not ask you to pay your bill if you have no insurance. 

All St. Jude patients are automatically qualified for this financial help. The St. Jude Financial Assistance Policy and the St. Jude Financial Assistance Statement in English and Spanish can be found at www.stjude.org. Type “financial assistance policy” or “financial assistance statement” in the search box. 

St. Jude does not try to collect unpaid bills from any patient or patient family. All services provided by St. Jude and all St. Jude departments or divisions that provide services to patients follow this financial assistance policy. 

Memphis St. Jude staff members in Patient Registration, Social Work, and some Managed Care staff members (phone 901-595-2670) are here to help you find out if your child is eligible for Medicaid if you have no health insurance.  

If you are approved for Medicaid, Medicare, Tricare, or have changes to your private insurance, please tell a Patient Registration staff member right away. Call Patient Registration at 901-595-2010 (toll-free: 1-866-278-5833, extension 2010). If you are an affiliate patient, please also let the affiliate office know of any changes. 

A primary care physician (PCP) is a doctor who your insurance company may require you to call or visit before insurance will consider paying for your child to see another doctor. You must check with your insurance company to know if you must contact a PCP before receiving treatment at St. Jude or elsewhere. 

If your insurance company requires a PCP referral, please attempt to get one from that doctor before receiving treatment. Give the referral information to St. Jude Patient Registration right away. Call Patient Registration at 901-595-2010 (toll-free: 1-866-278-5833, extension 2010). 

In the Affiliate Clinic, please call the front office staff.

You will need to check with your insurance company about whether or not a referral is needed for the first time the patient receives services outside St. Jude. If your insurance plan requires a PCP referral for these services, please call your PCP and request a referral.  

If you get a PCP referral for services outside St. Jude, please give that information to a staff member in the St. Jude Outside Professional Services. Call them at 901-595-5755 (toll-free: 1-866-278-5833, extension 5755). If you call this number after hours, you may leave a voice mail message with the PCP referral information.  

The same process applies in the Affiliate Clinics.  

If the St. Jude affiliate clinic or hospital provides the care or service the patient needs, you will not have to pay for services pre-authorized by St. Jude beyond the amount your insurance covers. Before looking to St. Jude for payment, the St. Jude staff does ask the providers of care given outside St. Jude to file for insurance benefits for services authorized by St. Jude. 

You will never have to pay for services authorized by St. Jude. If your insurance will not pay or you do not have insurance, all costs for treatment authorized in advance by St. Jude will be covered. 

If St. Jude sends your child for services outside St. Jude that are authorized and scheduled by us, you will receive an appointment card from St. Jude. Please have that appointment card with you when you register for treatment away from St. Jude. This will remind the outside provider that your child is a St. Jude patient. 

If you have insurance, please give the provider your most current insurance information. That way the provider may call St. Jude, if needed, to find out if St. Jude will pay for the medical visit in case insurance does not.  

Affiliates may have a different scheduling system, and, if so, they will tell you how their system works. 

If St. Jude sends the patient to an affiliate area for any service, make sure the affiliate clinic sees your child first before you go to any other appointment in the area. Please use the steps listed above for any appointments in the affiliate area. 

If your child is not a patient at one of the St. Jude affiliate sites and you receive bills from providers outside St. Jude or have questions about what St. Jude will pay for, please call Outside Professional Services. Call them at 901-595-5755 (toll-free: 1-866-278-5833, extension 5755). 

If your is a patient at a St. Jude affiliate and you receive bills from providers in the affiliate city or have questions about what St. Jude will pay for there, please call the St. Jude affiliate clinic. An affiliate staff member will guide you on what to do. 

If any of your insurance information changes, call Patient Registration right away. Call them at 901-595-2010 (toll-free: 1-866-278-5833, extension 2010). 

Sometimes patients need medical attention while away from St. Jude or while in their home areas. Examples include: 

• Visiting a local emergency room for fever and neutropenia 
• Having the patient’s blood counts checked in a pediatrician’s office 
• Seeing a specialist in your home area 

St. Jude medical staff may offer recommendations for care, refer patients to outside providers for care and may even help arrange for that care. But, please understand that this does not mean that St. Jude will pay for those services.  

When you are thinking about seeking non-emergency care outside of St. Jude or outside a St. Jude affiliate clinic, be sure to talk to St. Jude medical staff to find out if this service will be authorized. That way you will know ahead of time whether St. Jude is going to cover the service. St. Jude only covers medical care in your home area if we have agreed beforehand to accept financial responsibility. 

In an affiliate area, St. Jude will pay for services by a non-affiliate provider beyond what insurance covers if: 

• the St. Jude affiliate clinic doctor orders the care, and 
• it has been authorized by St. Jude before the service is performed. 

1. Services for St. Jude LIFE Study patients that are not required by the patient’s research protocol 

2. Devices not covered: 

• Eyeglasses prescribed solely for problems unrelated to St. Jude treatment or the disease the patient is being treated for at St. Jude 
• Rehabilitation-related devices that are lost or damaged by the patient through neglect. This includes hearing aids and assistive listening devices 
• More than one prosthesis 
• Wheelchairs or other assistive devices supplied solely for patient convenience 

3. Medicines not covered include but are not limited to: 

• Coagulation factor concentrates or injections (shots) such as Hemlibra, except under urgent circumstances when medically required products cannot be obtained through medical insurance or state assistance programs 
• Human growth hormone 
• Medications used in treating spinal muscular atrophy 

4. Fertility expenses not covered:

• Pregnancy and abortion-related expenses 
• Fertility evaluations and expenses for retrieving and storing sperm or eggs for patients who will not or have not received therapy at St. Jude that could affect sexual organs (testes, ovaries) 
• If therapy could affect sexual organs, St. Jude will cover expenses for retrieving and storing sperm or eggs from the time the patient begins treatment at St. Jude or at a St. Jude affiliate until the patient is 35 years old. 

5. Home health services not covered: 

• Home health services for patients who are deemed (by approved St. Jude staff) medically able to visit the office of a home-area provider (except for services by St. Jude Children’s Research Hospital Home Care, LLC) 
• Private-duty nursing or custodial-type care 

6. Procedures not covered:

• Solid organ transplants, unless the transplant is needed as a result of cancer or its treatment 
• Routine dental services, unless the patient has a very weak immune system, has received therapy that will weaken the immune system, or will receive or has received radiotherapy to the mouth 
• Dental restoration unrelated to the disease or treatment for which a patient is being seen at St. Jude, unless it is needed to ensure safe delivery of treatment for the primary disease 

7. Other services not covered: 

• Convenience items and services, such as TVs and phones, during approved admissions to another hospital 
• Medical services given in the patient’s home area other than approved home health or hospice 
• Consults or services sought by the patient or the family other than those approved by St. Jude 
• Air ambulance transports not approved in advance by the St. Jude Memphis ICU attending doctor or hospital clinical director (or designee) 
• Routine psychiatric and psychological care delivered outside St. Jude or its affiliate clinics 
• Medical, psychiatric, and psychological care for patient caregivers not approved in advance by the hospital clinical director (or designee) 
• Rehabilitation services, including audiology services, delivered outside of St. Jude or its affiliate clinics 

If you feel that an exception to the policy is needed, talk to your child’s attending doctor at St. Jude. This staff member can discuss the situation with you and possibly request an exception from the hospital clinical director.