{"hospital":{"ccn":"050140","name":"KAISER FOUNDATION HOSPITAL FONTANA/ONTARIO","city":"FONTANA","state":"CA","zip":"92335","phone":"909-427-5000","ownership":"Voluntary non-profit - Private","website_domain":"kaiserpermanente.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Federal Poverty Guidelines Percentages Financial Assistance Discount From To 0% -200% 100% Discount (Full)","source_id":"fap-9913715a8aab5bc4","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"discount_tiers":{"value":[{"min_fpl_exclusive":"200","max_fpl_inclusive":"300","discount_percent":75},{"min_fpl_exclusive":"300","max_fpl_inclusive":"350","discount_percent":50},{"min_fpl_exclusive":"350","max_fpl_inclusive":"400","discount_percent":25}],"layer":"documented","quote":"Federal Poverty Guidelines Percentages Financial Assistance Discount From To 0% -200% 100% Discount (Full) 201% -300% 75% Discount (Partial) 301% -350% 50% Discount (Partial) 351% -400% 25% Discount (Partial)","source_id":"fap-9913715a8aab5bc4","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"asset_test":{"value":false,"layer":"documented","quote":"Assets are not considered income.","source_id":"fap-9913715a8aab5bc4","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Eligible insured patients receive DFA on the patient cost for all eligible services.","source_id":"fap-9913715a8aab5bc4","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"• Enrolled in a or likely eligible for a government health coverage program like Medicaid, Medicare Low Income Subsidy Program (LIS), or subsidized coverage from the Health Benefit Exchange.","source_id":"fap-9913715a8aab5bc4","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["proof_of_income"],"layer":"documented","quote":"Proof of income Providing proof of income helps us determine if you qualify.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Mail your completed application to: Kaiser Permanente MFA Program P.O. Box 7086 Pasadena, CA 91109-7086"},{"kind":"fax","detail":"Fax your completed application to 1-866-519-1693"},{"kind":"portal","detail":"visit kp.org/helppaybills and sign up to receive a link to our secure online application"},{"kind":"in_person","detail":"Drop off your completed application at your local Kaiser Permanente Admitting Department."}],"layer":"documented","quote":"Ways to apply Apply online kp.org/helppaybills Fax it in Fax your completed application to 1-866-519-1693 Mail it in Mail your completed application to: Kaiser Permanente MFA Program P.O. Box 7086 Pasadena, CA 91109-7086 Drop it off Drop off your completed application at your local Kaiser Permanente Admitting Department.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"If your application is complete, we will send you a letter with our decision within 30 business days.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"1-800-390-3507","layer":"documented","quote":"You can also call 1-800-390-3507.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"hours":{"value":"Monday through Friday, 8 a.m. to 5 p.m.","layer":"documented","quote":"Call us at 1-800-390-3507 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Pacific time to find the nearest Kaiser Permanente hospital that provides in-person assistance with your application.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"languages":{"value":["English","Spanish","Chinese","Tagalog","Vietnamese","Korean","Russian","Arabic","Armenian","Hindi","Hmong","Japanese","Khmer","Laotian","Mien","Navajo","Punjabi","Thai","Ukrainian"],"layer":"documented","quote":"Information is available in many languages in a screen reader accessible format.","source_id":"summary-8518fe7e40b6ca2c","checked_on":"2026-10-13","confidence":1.0,"support_count":0}},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-9913715a8aab5bc4","kind":"hospital_web","url":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/dfa/policy/dfa-policy-english-ada.pdf","title":"POLICY TITLE: Medical Financial Assistance","fetched_on":"2026-10-13","sha256":"9913715a8aab5bc4d812626ed269cc3fb8f13ff12eeaff7da48f0f93989b4b8f","effective_date":null},{"id":"summary-8518fe7e40b6ca2c","kind":"hospital_web","url":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/mfa/southern-california/english/mfa-plain-language-summary-scal-english-ada.pdf","title":"Medical Financial Assistance Policy Summary","fetched_on":"2026-10-13","sha256":"8518fe7e40b6ca2cc0365ececb92cc2c804b96b9893959093910f3c6efee34c9","effective_date":null},{"id":"summary-96a9937ce09d985c","kind":"hospital_web","url":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/support/2025-MFA-Program-Summary-MAS-English-ADA-v2.pdf","title":"Medical Financial Assistance Policy Summary","fetched_on":"2026-10-13","sha256":"96a9937ce09d985caeabc2641de12142fa7dae8a0d9f743699d8d408ebaded88","effective_date":null},{"id":"fap-763b665d4845ad87","kind":"hospital_web","url":"https://www.kaiserpermanente.org/help-paying-your-bill/medical-financial-assistance/documents","title":"download","fetched_on":"2026-10-13","sha256":"763b665d4845ad8732a89c3949138ea6742e798f1624b0168fefc0802052579d","effective_date":null}],"accuracy":null}