{"hospital":{"ccn":"051317","name":"ADVENTIST HEALTH CLEARLAKE","city":"CLEARLAKE","state":"CA","zip":"95422","phone":"707-994-6486","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:\ni. Patient has an active Medicaid plan.\nii. Patient is eligible for Medicaid; or\niii. Patients with current active Medicaid coverage, even if they did not have Medicaid coverage on the date of service","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:\nI. Work with Adventist Health to find other sources of payment, or coverage, from public and/or private payment programs;\nII. Submit a true, accurate, and complete confidential → Financial Assistance Application within the Application Period;\nIII. Provide a copy of patient’s or guarantor’s most recent pay stub (or certify that he or she is currently unemployed);\nIV. 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":"portal","detail":""},{"kind":"in_person","detail":""}],"layer":"documented","quote":"Information about this Policy is available on each hospital’s website home page and on any website where the patient pays a bill or accesses information about the patient’s account, posted in hospital areas that are accessible to the public, such as the emergency department and any rural health clinics waiting areas, included in writing on each billing statement, and by plain language summaries provided in writing to all patients. Hospital personnel shall direct patients, guardians, or family members who request Financial Assistance or information about Financial Assistance, or who the hospital personnel believe may be eligible for Financial Assistance to any hospital registration area or by phone to (844) 827-5047 to receive a paper copy of this Policy and an application form.","source_id":"fap-83ffdddfd7847c4f","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":"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:","source_id":"application-9144604435c57343","checked_on":"2026-10-09","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["Adventist Health Clear Lake"],"layer":"documented","quote":"Adventist Health Clear Lake 15630 18th Avenue Clearlake, CA 95422 707-994-6486","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}