{"hospital":{"ccn":"310017","name":"CHILTON MEDICAL CENTER","city":"POMPTON PLAINS","state":"NJ","zip":"07444","phone":"973-831-5000","ownership":"Voluntary non-profit - Private","website_domain":"atlantichealth.org","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Charity Care will cover 100% of hospital charges for patients with family gross income less than or equal to 200% of the federal poverty level","source_id":"summary-8f901b40dddaa32b","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":"An insured or underinsured patient has up to 365 days from the first post-discharge billing statement reflecting processing by an insurer to submit a completed application for financial assistance.","source_id":"billing-5c93a76bb7e18b91","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["photo_id","proof_of_income","social_security_letter","tax_return","pay_stubs","bank_statements","proof_of_residency"],"layer":"documented","quote":"**Proper patient and family identification documents, such as:**\n\n* Driver’s license\n* Social security card\n* Alien registry card\n* Birth certificate\n* Paycheck stub\n* Passport\n* Visa\n\n**Provide proof of gross income with one of the following:**\n\n* Actual gross income for the 12 months immediately preceding services\n* Actual gross income for the three months immediately preceding services\n* Actual gross income for the month immediately preceding services\n\n**Proof of assets as of the date of service, including items readily convertible into cash, such as:**\n\n* Stocks\n* Bonds\n* IRAs\n* CDs\n* Checking and savings accounts\n* Equity in a non-primary residence\n\nProof of New Jersey residency as of the date of service (emergency care may be an exception). Acceptable documents include:\n\n* Driver’s license\n* Utility bill\n* Federal income tax return\n* State income tax return\n* Lease","source_id":"fap-f59686d0d7aa22b8","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Send applications to the applicable mailing address below:\n\nChilton Medical Center 97 West Parkway    \n Attn: Financial Counseling    \n Pompton Plains, NJ 07444"},{"kind":"fax","detail":"You may bring your application to the hospital in person, mail it, fax it, or e-mail it."},{"kind":"email","detail":"You may bring your application to the hospital in person, mail it, fax it, or e-mail it."},{"kind":"in_person","detail":"You may bring your application to the hospital in person, mail it, fax it, or e-mail it."}],"layer":"documented","quote":"You may bring your application to the hospital in person, mail it, fax it, or e-mail it.","source_id":"summary-8f901b40dddaa32b","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":365,"layer":"documented","quote":"An uninsured patient has up to 365 days after the first post-discharge billing statement to submit a completed application for financial assistance.","source_id":"billing-5c93a76bb7e18b91","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days":{"value":10,"layer":"documented","quote":"The Financial Counseling Office makes a determination of whether the applicant is eligible no later than ten (10) working days from the day the completed initial application was received.","source_id":"billing-5c93a76bb7e18b91","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":{"value":120,"layer":"documented","quote":"For uninsured patients, the first post-discharge billing statement marks the beginning of the 120-day notification period in which no extraordinary collection actions (“ECA”) (defined below) may be initiated against the patient.","source_id":"billing-5c93a76bb7e18b91","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":null,"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-f59686d0d7aa22b8","kind":"hospital_web","url":"https://www.atlantichealth.org/patient-resources/financial-assistance","title":"Financial Assistance and Charity Care | Atlantic Health","fetched_on":"2026-10-11","sha256":"f59686d0d7aa22b843a788f37e5735032c3a088602008fd7410336a14839a6cc","effective_date":null},{"id":"application-0371adcfa1e0fd67","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/financial-assistance-application/FAA-English.pdf","title":"Atlantic Health System","fetched_on":"2026-10-11","sha256":"0371adcfa1e0fd67bdd84ce9705a4cdedea8bfa41cffb6c8b005d29e89d585af","effective_date":null},{"id":"summary-8f901b40dddaa32b","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/plain-language-statement/PLS-English.pdf","title":"Atlantic Health System (“AHS”), Inc.'s Financial Assistance ...","fetched_on":"2026-10-11","sha256":"8f901b40dddaa32b6f822613595f483a2a5196e0a5f2afb8fee4a13bfc96d9fb","effective_date":null},{"id":"billing-5c93a76bb7e18b91","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/ENGLISH_FA.pdf","title":"Billing and Collection Policy/Financial Assistance for Low- ...","fetched_on":"2026-10-11","sha256":"5c93a76bb7e18b911468c3312b2421311a3bef6d87c215127d00f138bb8835a2","effective_date":null},{"id":"fap-103988d5b78df339","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/ARABIC_FA.pdf","title":"Arabic Language","fetched_on":"2026-10-11","sha256":"103988d5b78df33905691bfbe95380c7d619ee899c3cdf43d980c3bc7c98cc7a","effective_date":null},{"id":"fap-987f033c4b715ce4","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/ARMENIAN_FA.pdf","title":"Armenian Language","fetched_on":"2026-10-11","sha256":"987f033c4b715ce457a2a4461cc3e3f960cfe6691f73836c25cb615c72bff87c","effective_date":null},{"id":"fap-e6460da0afed5ad6","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/BRAZILIANPORTUGUESE_FA.pdf","title":"Brazilian Portuguese Language","fetched_on":"2026-10-11","sha256":"e6460da0afed5ad650e92828837034363d05dc87260ab1d9c9fdc41f69491c30","effective_date":null},{"id":"fap-9af57483327a2885","kind":"hospital_web","url":"https://www.atlantichealth.org/content/dam/ahs/financial-assistance/CROATIAN_FA.pdf","title":"Croatian Language","fetched_on":"2026-10-11","sha256":"9af57483327a28852dcccbbf90f6cb4ae3c9d0b69ed05cdcf9989336c89b3bc3","effective_date":null}],"accuracy":null}