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Charit BRH – Charity Care and Discount Application 6-12-18_Armeniany Care

Financial assistance is available for eligible patients who cannot pay for part or all of the care that they receive from the Hospital. This summary briefly describes when financial assistance is available and how to apply for it. For comprehensive information, please review the Hospital’s full Financial Assistance-Discount and Charity Care Policy (Financial Assistance Policy).

Eligibility Requirements

Charity Care:  Patients who earn less than 200% of the federal poverty level and do not have sufficient assets to pay their bill may be eligible for free care.

Low Income Financial Assistance:  Patients who earn less than 350% of the federal poverty level and do not have insurance or have high medical bills may be eligible for a discounted rate.  Individuals who are eligible for discounted care may negotiate a payment plan with the Hospital and will be charged at no more than the Medicare rate (or the Medi-Cal rate, if there is no rate established by Medicare).

How to Apply
An individual can apply for financial assistance by completing the Financial Assistance Application (Application) and  submitting it to the Patient Financial Services Department.  An applicant may be asked to provide recent pay stubs or income tax returns to document family income.  An applicant for charity care may also be asked to provide information about his or her assets and to authorize the Hospital to obtain account information from financial or commercial institutions to verify that information.

Copies of Full Policy and Application Available

You can obtain copies of the Financial Assistance Policy and Application on our website at www.barlowhospital.org or from staff at the Hospital’s admissions areas.  If you would like us to mail you a free copy of the Financial Assistance Policy and Application, please make a request to the Patient Financial Services Department.


Contact the Financial Services Department for Questions or Help

For more information about the Hospital’s financial assistance program, please visit our Financial Services Department at our Main Campus on Stadium Way (213-250-4200 ext.3329) or contact our remote Patient Financial Services Provider at 844-288-2025. for assistance with completing the financial assistance application process.

Translations Available

Translations of the Policy, Application, and this summary are available in Spanish and Armenian.

For comprehensive information, please follow the links below to see the policy and access an applicaiton.

Click on the links below to access each document.

Սեղմեք ստորև նշված հղումները՝ համապատասխան փաստաթուղթը դիտելու համար։

Summary

Resumen de la Política de Asistencia Financiera

Ֆինանսական օժանդակության քաղաքականության սեղմագիր

Financial Assistance – Charity Care Policy 

Asistencia Financiera- Política de Atención de Beneficencia y con Descuento

Ֆինանսական օժանդակության, բարեգործական խնամքի և զեղչերի քաղաքականություն

Charity Care and Discount Application

SOLICITUD DE ASISTENCIA FINANCIERA

Ֆինանսական օժանդակության դիմում