CHENANGO MEMORIAL HOSPITAL

"Less than 200% of FPG 100%"

documented · checked 2026-10-10 · Financial Assistance Program Plain Language Summary

"Annual Family Income Amount of Discount Less than 200% of FPG 100% 201% to 250% of FPG 83.5% 251% to 300% of FPG 67%"

documented · checked 2026-10-10 · Financial Assistance Program Plain Language Summary

"Patients with insurance, whose health insurance carrier has deemed a service noncovered or has exhausted a benefit level (i.e., Physical Therapy), will be eligible for the Financial Assistance Program."

documented · checked 2026-10-10 · **Financial Assistance Policy**

"Any patient that qualifies for Medicaid will automatically have any unpaid financial responsibility for medically necessary services received for the 12 month period prior to the Medicaid qualification date adjusted as Financial Assistance."

documented · checked 2026-10-10 · **Financial Assistance Policy**

"Documents required along with completed application are: 1. Pay Stubs: last 30 days 2. Other Income such as Investments, Child Support, Unemployment, Social Security, Workers’ Compensation 3. Most Recent Tax Return: if self-employed 4. Self-Attestation: if no income is reported 5. Family size: number of individuals in household"

documented · checked 2026-10-10 · **Financial Assistance Policy**

"Eligibility will be determined within 30 days of receipt of your completed application."

documented · checked 2026-10-10 · Patient Financial Assistance

"UHS will refrain from initiating any extraordinary collection actionss (ECA) for at least 240 days from the date of the first discharge billing statement for the care."

documented · checked 2026-10-10 · **Financial Assistance Policy**

"Financial Assistance Application and Plain Language Summary are available in English, Spanish and Russian."

documented · checked 2026-10-10 · Financial Assistance Program Plain Language Summary