NorthShore Patient Privacy Policy

Notice of Privacy Practices and Policies ( PDF )

NorthShore Payment Policy/Cost of Services

The Health Centers are open to the public.

  • Self pay charges for health care are determined on a sliding scale according to the responsible party's income.
  • Cash payments and private insurance are gladly accepted.
  • All clients must pay a minimum fee for each office visit.
  • Medicaid and Hoosier Healthwise payments are accepted.
  • Charges for dental work are assessed based on the services provided and ability to pay.
  • Payments must be made at the time services are rendered.

Northshore Health Centers will assess each patient's ability to pay prior to rendering services. It is the responsible party's obligation to furnish all financial documents requested by Northshore Health Centers.

While we provide a wide range of services, and sometimes refer patients to specialists and others not affiliated with Northshore Health Centers. Those fees must be negotiated directly by the patient with the provider. Northshore Health Centers is not involved in these negotiations, and is not responsible for paying such fees.

The Healthy Indiana Plan (HIP) www.hip.in.gov is a new, affordable health insurance program for uninsured adult Hoosiers. The program is sponsored by the State and only requires minimal monthly contributions from the participant. If you are interested in the Healthy Indiana Plan, you can enroll at NorthShore Health Centers.

NorthShore is also an enrollment site for Hoosier Healthwise which provided Medicaid for Pregnant Women & Children. Visit Indiana Medicaid www.indianamedicaid.com for more information. 

Speed up your intake process by filling out the packet that applies to you.
Uninsured or Under Insured Adult Intake Packet 2011
extra forms are included to see if you qualify for a discount
Insured Adult Intake Packet 2011

Uninsured or Under Insured Pediatrics Intake Packet 2011
extra forms are included to see if you qualify for a discount
Insured Pediatrics Intake Packet 2011

Dental Intake Packet 2011