{"hospital":{"ccn":"050013","name":"ADVENTIST HEALTH ST HELENA","city":"SAINT HELENA","state":"CA","zip":"94574","phone":"707-963-3611","ownership":"Voluntary non-profit - Private","website_domain":"adventisthealth.org","system":null},"version":2,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Adventist Health shall provide charity care (zero patient responsibility) for Self-Pay Patients at or below 200% or less of the Federal Poverty Level.","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Financial Assistance may be applied to uninsured patients, as well as the patient liability for patients with insurance, including charges determined uninsured for the hospital stay, coinsurance, copayment, deductible amounts and other liabilities for medically necessary hospital services except for Medicaid SOC","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"Adventist Health will apply a presumptive Charity Care determination of 100% assistance in the following situations: i. Patient has an active Medicaid plan.","source_id":"fap-83ffdddfd7847c4f","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["proof_of_income","tax_return","pay_stubs"],"layer":"documented","quote":"To be considered for Financial Assistance under this policy, a patient or guarantor must: I. Work with Adventist Health to find other sources of payment, or coverage, from public and/or private payment programs; II. Submit a true, accurate, and complete confidential → Financial Assistance Application within the Application Period; III. Provide a copy of patient’s or guarantor’s most recent pay stub (or certify that he or she is currently unemployed); IV. Provide a copy of patient’s or guarantor’s most recent Federal Income Tax Return (including all schedules)","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Writing to: Adventist Health, ATTN: Financial Assistance, P.O. Box 677000, Paradise, CA 95967"},{"kind":"in_person","detail":"Going to the registration area, emergency room, or admissions areas"},{"kind":"in_person","detail":"Speaking with an Adventist Health facility financial counselor"},{"kind":"phone","detail":"Calling us at 1-844-827-5047 (or local hospital – See appendix B of this policy)"}],"layer":"documented","quote":"Individuals can get information about the Financial Assistance Policy, a copy of our Plain Language Summary, and an application in different languages, free of charge, by: a. Going to the registration area, emergency room, or admissions areas b. Speaking with an Adventist Health facility financial counselor c. Going to the website for Adventist Health: https://www.adventisthealth.org/patient-resources/financial-assistance/ d. Calling us at 1-844-827-5047 (or local hospital – See appendix B of this policy) e. Writing to: Adventist Health, ATTN: Financial Assistance, P.O. Box 677000, Paradise, CA 95967 f. Patients may get a paper copy of this Financial Assistance Policy upon request by contacting any of the five contacts listed above","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Application Period – The period during which Adventist Health must accept and process an application for financial assistance under its Financial Assistance Policy submitted by an individual in order to have made reasonable efforts to determine whether the individual is eligible for financial assistance under the policy. The Application Period begins on the date the care is provided and ends on the latter of the 240th day after the date that the first post-discharge billing statement for the care is provided or at least 30 days after Adventist Health provides the individual with a written notice that sets a deadline after which ECAs may be initiated.","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"1-844-827-5047","layer":"documented","quote":"Calling us at 1-844-827-5047 (or local hospital – See appendix B of this policy)","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["Adventist Health St. Helena"],"layer":"documented","quote":"Adventist Health St. Helena 10 Woodland Road St. Helena, CA 94574 707-963-3611","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"application-9144604435c57343","kind":"hospital_web","url":"https://www.adventisthealth.org/documents/system/financial-assistance-policy-and-application.pdf","title":"[PDF] FINANCIAL ASSISTANCE POLICY - Adventist Health","fetched_on":"2026-10-09","sha256":"9144604435c57343de648406e5367fdfbd2b1258a6a66924733483633c1f94b6","effective_date":null},{"id":"fap-83ffdddfd7847c4f","kind":"hospital_web","url":"https://www.adventisthealth.org/documents/system/financial-assistance-policy-california.pdf","title":"[PDF] Financial Assistance Policy for California-Based Hospitals","fetched_on":"2026-10-09","sha256":"83ffdddfd7847c4f8b5ffc77d2b1f02e4126b215f0a329902a320eea40a4265c","effective_date":null}],"accuracy":null}