CHS Financial Assistance Program
CHS Hospital Financial Assistance Policy: Plain Language Summary
The CHS Hospital Financial Assistance Policy (Policy) applies to hospital services provided at a System Hospital for emergency or other medically necessary care. You will not be denied medically necessary hospital services based on your inability to pay. It does not include physician and other provider services provided at a System Hospital. Additionally, dental, occupational, physical and speech therapy services are also not covered by this Policy.
Financial Ability: Financial assistance for medically necessary services is available on a sliding scale of up to 100% of charges, and up to a full waiver of co-payments and/or deductible after third-party insurance proceeds, based on financial need (i.e., uninsured and underinsured patients). Patients qualify for 100% financial assistance if their family income is at or below 300% of the Federal Poverty Level Guidelines (FPL). Lesser discounts are available for patients with a family income between 301% and 400% of the Federal Poverty Level Guidelines. Liquid assets will not be considered when income is greater than 150% of the FPL. Further, CHS will not use gross charges when billing individuals who qualify for financial assistance when such eligibility is known at the time of billing.
Primary Service Area: CHS shall extend free or discounted care to eligible individuals, residing in the United States, for non-emergent medically necessary services. The medical condition of the patient shall not be a factor in determining eligibility.
Applying for Financial Assistance: Determination of eligibility for financial assistance discounts shall occur as closely as possible to the time of the provision of service. When financial assistance is not identified at the time of service, CHS will generally accept applications within 12 months of the first "post-discharge" billing statement.
In general, patients requesting financial assistance will be required to complete the CHS Financial Assistance Application Form. A completed application should be submitted within thirty (30) days of its receipt. The financial assistance eligibility is assessed as of the date the application was received.
Individuals will be notified when financial assistance applications are deemed incomplete. Such notification shall include the information needed to complete the application, the timeframe the information is requested and contact information to provide missing information and to obtain information about assistance in completing the financial assistance application.
Where to Obtain Information: To apply for financial assistance, patients may:
- Download the Policy, plain language summary, application and instructions online at http://www.chsli.org/chs-financial-assistance-program (or please see below). Additionally, copies of the Policy, plain language summary, application form and instructions are also available in patient registration and emergency department locations. These documents are available in English and Spanish.
- Assistance understanding the Policy and with the Financial Assistance Application process is available.
- Request free copy of the Policy, plain language summary, application and instructions by mail or to obtain more specific details on the Financial Assistance process by contacting the Financial Assistance Department:
Catholic Health Services of Long Island
Financial Assistance Department
245 Old Country Road
Melville, NY 11747