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An appointment request can be made online. We will confirm your appointment by e-mail or telephone. Please send your request at least 48 hours before your desired appointment time.

Online Payments

Welcome to the Online Payment Center. You may pay your hospital bills here by credit/debit card. For your convenience please fill out the below payment form. All information will be kept secure and confidential.


This form is to register for our Patient Pre-registration Program. By registering with us you can receive peace of mind that we have your medical information.Please Print clearly and Complete the following information.

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    Medical Services

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    Financial Assistance Policy


    To provide a mechanism whereby Self Pay patients may qualify for sponsorship from Federal, State, and/or local entities for payment of healthcare services rendered by Chestatee Regional Hospital that have been determined to be medically necessary. Elective services are NOT within the scope of this policy and must be paid in advance of services provided.

    That being said, it is the policy of Chestatee Regional Hospital to provide appropriate healthcare services to all patients without discrimination and regardless of their ability to pay. In order for Chestatee Regional Hospital to continue to provide healthcare services to its community, it is essential for patients to assume full responsibility for payment for services. However, not all patients have the ability to pay, therefore Chestatee Regional Hospital offers assistance with determination of eligibility for charitable programs. Our representatives will assist patients with completing an application for financial assistance.

    Criteria to be considered in the determination of eligibility for sponsored assistance programs includes but is not limited to:

    Guarantor's gross income
    Guarantor's net worth (Assets and Liabilities)
    Guarantor's employment status and earning capability
    Catastrophic illnesses that incur medical bills that exceed household income


    Self Pay Patient is a designation for patients without active healthcare insurance on the date of service.

    Indigent Care Trust Fund (ICTF) is a state-sponsored program that subsidizes care for low-income individuals at participating hospitals. Hospitals receive a small percentage of the account balance from the Disproportionate Share Hospital (DSH) program, under the umbrella of the ICTF. The remaining balance is written off. This subsidized care for Georgia residents is available on both an inpatient and outpatient basis, regardless of whether there is an emergency. Patients residing outside of Georgia are eligible for ICTF determinations when the services provided are for emergency care.

    Indigent is a designation for patients with an income between 100% and 125% of the federal poverty level guidelines as published by the United States Department of Health and Human Services. Indigent patients are eligible under the state Indigent Care Trust Fund for a 100% adjustment write-off. (This means that after the account has been adjusted, the account shows no balance, however only a small percentage is actually paid by the fund and the remaining amount is written off)

    Charity is a designation for patients with an income between 150% and 200% of the federal poverty level guidelines as published by the United States Department of Health and Human Services. Charity patients are eligible under the state Indigent Care Trust Fund for an adjustment write-off of 75%, 50%, or 25% on a sliding scale of the above poverty guidelines. (This means that the account will show having been adjusted the sliding scale percentage, however the actual payment from the fund is only a small percentage of that adjustment, not the full percentage amount. The part of the full percentage that is not paid is written off).

    Hospital Authority of Lumpkin County Indigent Care (Charity) Fund is a local charity fund established in 1985 to offset the cost of hospital medical care for the indigent residents of Lumpkin County, GA.


    When a patient is determined to have no active healthcare insurance coverage, that patient will be designated as Self Pay and should complete a Self Pay Application for Financial Assistance (see link below). This application and all documentation must be received by the Business Office within 20 days from the date of request, unless extenuating circumstances exist. The prospective Indigent and/or Charity accounts must remain in a Self Pay financial class and regular collection efforts will continue until the application and documentation is received. These accounts are not to be left on the active A/R indefinitely, but adjusted off to Bad Debt and referred to a collection agency if the appropriate information is not received in a timely manner.

    Self Pay Policy

    This application is reviewed by the hospital's Financial Counselor or designee, who will make a determination of classifying the patient's status as Indigent, Charity, or Uninsured (ineligible for indigent or charity funds). The hospital Business Office will work with Uninsured patients to establish payment arrangements and/or discounts. Extenuating factors such as large medical bills or multiple medical bills will be taken into consideration.

    The patient will receive a letter notifying them of Indigent/Charity qualification after the determination has been made.