JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON

"If your family income is less than or equal to 200% of the FPG, you may qualify for free hospital or hospital clinic care."

documented · checked 2026-10-13 · Northwell Health Financial Assistance Policy Plain ...

"Northwell Health may also: a. Request the patient participate in joint efforts to apply for alternative sources of payment for the health care services provided and possibly obtain health care coverage from public and private payment programs; b. Take into account the patient’s available assets exceeding $10,000 (excluding primary residence and a vehicle used for daily transport to school or work). Northwell Health will only consider 25% of the total “unencumbered value” of available assets, which will be added to Family Income amounts to determine eligibility;"

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Underinsured: The patient has some level of healthcare insurance or third-party assistance but may have out-of-pocket expenses that exceed a patient’s financial abilities."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Other sources of data used to make a presumptive eligibility decision may include the patient’s participation in certain programs or the availability of externally obtained information such as: 1. State-funded prescription programs; 2. Homeless or received care from a homeless clinic; 3. Participation in Women, Infants and Children programs (WIC); 4. Food stamp eligibility; 5. Subsidized school lunch program eligibility; 6. Eligibility for other state or local assistance programs that are unfunded (i.e. Medicaid spend-down); 7. Low income/subsidized housing is provided as a valid address; 8. Patient is deceased with no known estate; 9. Patients enrolled in limited service Medicaid programs that use a defined family income at or below 100% of the Federal Poverty Guidelines, specifically, Medicaid for Pregnant Women-Pregnancy Related Services Only or Family Planning Services and EMSA;"

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Applications may be obtained in the following ways: a) On-line at Northwell Health web address: www.northwell.edu/manage-your-care/financial-aid-programs/financial-assistance-program;"

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"In making the determination of financial assistance, some or all of the following items may need to be provided: a. A completed application; b. Prior year’s tax return(s); c. Minimum of two most recent pay stubs; d. Minimum of three most recent bank statements for savings and checking accounts; e. Other proof of income as defined by ‘Family Income’ listed in the Definitions section of this policy; f. All outstanding credit card statements; and g. Documentation of other debt as listed in the Definitions section of this policy."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Patients are encouraged to apply for financial assistance within ninety (90) days from the date noted on the first post-discharge billing statement; however patients are permitted a minimum of two hundred and forty (240) days to apply and submit a completed application."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"The notification of eligibility for financial assistance should be received by the patient in writing within thirty (30) days of submission of a completed application."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Northwell Health, or its agents, will not undertake ECA’s until 120 days after the hospital provides a patient with the first post-discharge billing statement."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Phone: 1.800.995.5727"

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"Northwell Health’s Financial Assistance Policy Application and Plain Language Summary of the Policy are available in English and the primary language of populations with Limited English Proficiency."

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures

"John T. Mather Memorial Hospital Financial Assistance Coordinator 75 North Country Road Port Jefferson, NY 11777 Phone: 631.476.1320 ext. 4037 Web address: www.matherhospital.org/financial-aid.php"

documented · checked 2026-10-13 · Financial Assistance Policy & Procedures