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Financial Assistance Programs & Charity Care

Financial Services

If you believe you will have difficulty paying your hospital bill, please call our financial counselor at 661.253.8236. If you have a question about your bill after discharge, please call our business Services at 661.200.1110.

Financial Assistance Program (FAP) / Charity Care

Discount Payment and Free Care Summary

HMNH offers financial assistance to patients who are uninsured (self pay) or insured patients with high medical costs. Please visit the Patient Access Services Department in the Main Admitting area or call 661.200.1050 between the hours of 7:00 AM – 7:00 PM, Monday through Friday.

  • This program covers medical necessary services. Medicare defines medically necessary care as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
  • All documents related to the FAP are provided in English, Spanish and to “a group that constitutes the lesser of 1,000 individuals or 5% of the community served by the hospital.”
  • Self pay patient means a patient who does not have insurance coverage including but not limited to auto, liability, workers’ compensation, Medicare or Medi-Cal. Self pay charity discounts apply to a patient whose family income is at or below 350% of the Federal Poverty Level (FPL). HMMH allows up to 400% of the (FPL).
  • Patients with high medical costs (a person whose family income is at or below 350% of the (FPL). HMNH allows up to 400% of the FPL), For this purposes high medical costs means any of the following:
    • Annual out of pocket costs incurred by the individual at Henry Mayo Newhall Hospital that exceed 10% of the patient’s family income in the prior 12 months
    • Annual out of pocket expenses that exceed 10% of the patient’s family income, if the patient provides documentation of payment for the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months.
    • Underinsured patients whose family income is at or below 400% of the FPL and whose out of pocket expenses do not exceed 10% of the patient’s family income, may qualify under HMNH’s extended charity or discount policy.
  • FAP application shall be initiated by Patient Access Services (PAS) personnel, or retrospectively, Business Services. In addition, the patient or patient representative may ask for the application in person or by phone or mail.
  • Upon receipt, Henry Mayo Newhall Hospital (HMNH) reviews the application, and approves or denies it based upon the submitted documentation and the discount Payment and Charity Care Programs’ criteria. Denial of the application is based solely upon the criteria submitted by the patient and/or responsible party and is rejected by not meeting the policy guidelines. The patient and/or responsible party will be notified of the application decision, in person, if possible; otherwise through a mailing.
  • Once the application and all requested documentation are received, HMNH will strive to review the application prior to the patient’s discharge, but no later than 30 days of receipt of application. If all requested documentation is not received, the application will be denied. Exceptions to this requirement will be reviewed if the additional supporting documentation is received within 30 days of the initial request.
  • Patient payment responsibility will be assigned based upon a sliding scale including family size and annual income. Upon approval, the patient will not be charged more for emergency or other medically necessary care than the amounts generally billed (AGB) to individuals who have insurance covering such care. The patient responsibility will be based upon Medicare allowable rates: DRG, APC, Fee schedule. The sliding scale for patient income is directly related to the established Federal Poverty Level (FPL).

Additional Information

Based upon specific qualifications and approved eligibility, you may be eligible to receive health benefits through Medicare, Medi-Cal, CCS, or Healthy Families. Below is information on how you can contact those agencies, if you desire. Upon request, we can provide you with paper applications for Medi-Cal, CCS, and/or Healthy Families.

Health Benefit Exchange
Phone: 800.300.1506
http://www.coveredca.com

Medi-cal
Phone: 1.877.597.4777

http://www.ladpss.org
Select :

  • Customer Service Center (left margin under OTHER RESOURCES)
  • Medi-Cal (2nd paragraph)
  • Medi-Cal Application (middle column, 7th option)

CCS
Phone: 1.800.288.4584
http://www.dhs.ca.gov

  • Left column – Forms, Laws & Publications
  • Right column – Forms
  • Right column – Applications
  • Near bottom – Applications to Determine GHPP (2 sections to print)

Medicare
Phone: 1.800.772.1213
Internet application: https://s044a90.ssa.gov/apps6z/ISBA/main.html

California Health Exchange
Phone: 1.844.342.6604
http://www.coveredca.com

Applications

Financial Assistance Program (FAP) - Click Here
Charity Care Application - Click Here
Applicacion en espanol - Click Aqui
Billing and Collection Policy - Click Here

Click here to learn about Financial Policies

Click here to learn about Financial Application Process & Application Review Process

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