{"hospital":{"ccn":"051321","name":"HEALDSBURG HOSPITAL","city":"HEALDSBURG","state":"CA","zip":"95448","phone":"707-431-6500","ownership":"Voluntary non-profit - Private","website_domain":"providence.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"300","layer":"documented","quote":"Annual family income, adjusted for family size, is at or below 300% of the current FPL guidelines, The patient is determined to be financially indigent and qualifies for Charity Care 100% write-off on patient responsibility amounts for Eligible Services.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Financial assistance is available to both uninsured and insured patients if they meet the requirements of this policy.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"Patients who are participating in state Medicaid programs are eligible for presumptive assistance.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","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":"Documentation of income will be limited to recent pay stubs or income tax returns.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Send your completed application to: Healdsburg District Hospital Attn: Financial Assistance 1375 University Avenue Healdsburg, CA 95448"},{"kind":"in_person","detail":"advise patient financial services staff at or prior to the time of discharge that assistance is requested"},{"kind":"portal","detail":"by visiting www.providence.org/financialhelp"}],"layer":"documented","quote":"Patients may request and submit a Financial Assistance Application, which is free of charge and available at the Providence facility, or by the following means: advising patient financial services staff at or prior to the time of discharge that assistance is requested, by mail, or by visiting www.providence.org/financialhelp.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"The FAP-Eligible Time Period for (i) hospital services is the 240-day period of time; and (ii) clinic services is the 90-day period, in each case that a patient has to submit a Financial Assistance Application to Providence.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days":{"value":30,"layer":"documented","quote":"Patients will receive notification of FAP eligibility determination within 30 days of submission of the completed Financial Assistance Application and necessary documentation.","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":null,"hours":null,"languages":{"value":["English","Español"],"layer":"documented","quote":"* Languages\n  + [English](https://www.providence.org/locations/norcal/healdsburg-district-hospital/patients-and-visitors/billing)\n  + [Español](https://es.providence.org/locations/norcal/healdsburg-district-hospital/patients-and-visitors/billing)","source_id":"billing-38f7c1bf752ca976","checked_on":"2026-10-11","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Healdsburg Hospital"],"layer":"documented","quote":"Providence Hospitals in Northern California\n\nProvidence St. Joseph Hospital  Providence Redwood Memorial Hospital\nProvidence Santa Rosa Memorial Hospital  Providence Queen of the Valley Medical Center\n\nNorCal Health Connect Hospitals\n\nPetaluma Valley Hospital  Healdsburg Hospital","source_id":"fap-561d6a64ec482342","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-f6a152b908eb285f","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/providence/norcal/files/healdsburg/financial-assistance-policy-english.pdf","title":"HEALDSBURG DISTRICT HOSPITAL","fetched_on":"2026-10-11","sha256":"f6a152b908eb285f443fb1a5f6404d0d3be6440b63d2becd3afb2d288ff4829c","effective_date":null},{"id":"billing-38f7c1bf752ca976","kind":"hospital_web","url":"https://www.providence.org/locations/norcal/healdsburg-district-hospital/patients-and-visitors/billing","title":"Billing | Healdsburg Hospital | Providence","fetched_on":"2026-10-11","sha256":"38f7c1bf752ca9760a39630e5f1d3647ab0ed7c93714c942aec0bb228d5a4d6b","effective_date":null},{"id":"fap-561d6a64ec482342","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/ca/fa-policy-english.pdf?rev=1be054a423d24c79908ce0d9d66b97b4&hash=3AE35D0EFD0E4260001393E9136D2B88","title":"Financial Assistance Policy – English","fetched_on":"2026-10-11","sha256":"561d6a64ec4823422d6ced4b0a0cbffa0be2a348bbd3de139165fc8e121e3980","effective_date":null},{"id":"billing-3c5d6a5baa8fe3a4","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/shared/files/bill-pay/surprise-billing-ca/ca-model-disclosure-notice-english.pdf","title":"Learn more about your rights","fetched_on":"2026-10-11","sha256":"3c5d6a5baa8fe3a43a0c5a26f8623af3af0ed0ded11a813315fca5794d63978b","effective_date":null}],"accuracy":null}