LONG ISLAND COMMUNITY HOSPITAL

"Patients qualify for 100% financial assistance if their family income is at or below 300% of the Federal Poverty Level Guidelines (FPL)."

documented · checked 2026-10-13 · Financial Assistance Policy | Catholic Health Long Island

"Eligibility Percentage 100% 90% 80% % of Poverty Level 0% - 300% 301% - 350% 351% - 400%"

documented · checked 2026-10-13 · **Financial Assistance Eligibility Percentages**

"Assets, subject to the exclusions listed below, may be considered for individuals with income greater than or equal to the federal poverty level to 'upgrade' the amount owed, up to the maximum payment amount, but not to deny financial assistance."

documented · checked 2026-10-13 · Financial Assistance Policy | Catholic Health Long Island

"Underinsured Patients – Patients with health insurance but have spent more than ten percent (10%) of their gross income on out-of-pocket medical expenses in the past twelve months. Underinsured patients may receive financial assistance for medically necessary services of up to 80% discount of the amount that would have been paid pursuant to such patient's insurance cost sharing."

documented · checked 2026-10-13 · **Financial Assistance Eligibility Percentages**

"Presumptive Eligibility – Patients are presumed to be eligible for financial assistance discounts on the basis of individual life circumstances (e.g. homelessness, patients who have no income, patients who have qualified for other financial assistance programs, etc.) Catholic Health shall grant 100% financial assistance discounts to patients determined to have presumptive financial assistance eligibility."

documented · checked 2026-10-13 · Financial Assistance Policy | Catholic Health Long Island

"Acceptable forms of documentation to support family income (patient/guarantor and spouse) include the following: o Four (4) most recent pay stubs o Copy of Social Security payments that you and/or your spouse receive (benefit award letter or bank statement) o Copy of unemployment benefits o Copy of workers compensation benefits o Other income (e.g., alimony/maintenance, rental income, veterans’ benefits) o Three (3) most recent bank statements (checking and savings) (all pages) o Proof of student status (unofficial transcript or current class schedule) o Proof of support assistance from another person (letter from person supporting you if you are not paying rent) o Prior year tax return"

documented · checked 2026-10-13 · Catholic Health Services of Long Island

"Complete, sign, date and return application, along with supporting documentation to: Catholic Health Services of Long Island 320 South Service Road Melville, NY 11747 Attn: Financial Assistance Department"

documented · checked 2026-10-13 · Catholic Health Services of Long Island

"Upon receipt of your completed application and all required documents, your application will be reviewed and our determination will be sent to you in writing within thirty (30) days."

documented · checked 2026-10-13 · Catholic Health Services of Long Island

"Catholic Health will not take "extraordinary collection actions" (lawsuits, arrests, liens, reporting of adverse information to credit agencies, or other similar actions) against individuals until it has made reasonable efforts to determine whether a patient is eligible for financial assistance; but not before 120 days from the first post-discharge billing statement."

documented · checked 2026-10-13 · Financial Assistance Policy | Catholic Health Long Island

"If you have any questions feel free to contact us at (631) 465-6321."

documented · checked 2026-10-13 · Catholic Health Services of Long Island

"These documents are available in English and Spanish."

documented · checked 2026-10-13 · Financial Assistance | Catholic Health Long Island

"System Hospital – A hospital within the Catholic Health System that is required by New York State to be licensed or registered or similarly recognized as a hospital, including Good Samaritan University Hospital, Mercy Hospital, St. Catherine of Siena Hospital, St. Charles Hospital, St. Francis Hospital & Heart Center® and St. Joseph Hospital."

documented · checked 2026-10-13 · Financial Assistance Policy | Catholic Health Long Island