{"hospital":{"ccn":"330229","name":"BROOKS-TLC HOSPITAL SYSTEM, INC","city":"DUNKIRK","state":"NY","zip":"14048","phone":"716-366-1111","ownership":"Voluntary non-profit - Private","website_domain":"brookshospital.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Household income less than or equal to 200% of the FPL is awarded 100% discount.","source_id":"fap-fb0b48f6f068c204","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":"Underinsured: patients whose paid medical expenses have exceeded 10% of their income in the last 12 months.","source_id":"fap-fb0b48f6f068c204","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":["proof_of_income","tax_return","pay_stubs","medicaid_denial"],"layer":"documented","quote":"Brooks-TLC Hospital System, Inc. will require a completed Financial Assistance application and proof of income such as a tax return or pay stubs. We may also request a Medicaid denial letter but not required.","source_id":"summary-2dccf3d993a2202f","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Send a completed form to Brooks-TLC Hospital System, Inc."},{"kind":"in_person","detail":"leave it with the cashier located in the main registration area."}],"layer":"documented","quote":"Send a completed form to Brooks-TLC Hospital System, Inc. or leave it with the cashier located in the main registration area.","source_id":"summary-2dccf3d993a2202f","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"Decisions regarding financial assistance are rendered within 30 days from the receipt date of the completed application.","source_id":"fap-fb0b48f6f068c204","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":{"value":"716-363-7221","layer":"documented","quote":"Please contact our Facilitated Enroller at 716-363-7221 for free confidential assistance.","source_id":"summary-2dccf3d993a2202f","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-328b555c65576987","kind":"hospital_web","url":"https://brookshospital.org/patient-information/patient-financial-services/financial-information","title":"Financial Assistance Program - Brooks-TLC Hospital System, Inc.","fetched_on":"2026-10-11","sha256":"328b555c65576987f9d3e08fa8caef0b41022588315a37fc4db4f7831599732f","effective_date":null},{"id":"summary-2dccf3d993a2202f","kind":"hospital_web","url":"https://brookshospital.org/wp-content/uploads/2025/10/1121463-K-BMH-Financial-Assistance-Summary-2024.pdf","title":"[PDF] 1121463 K BMH Financial Assistance Summary","fetched_on":"2026-10-11","sha256":"2dccf3d993a2202fbc8ffb6af24925dfcb2c33a13a799d5e8c1ba24184f01faf","effective_date":null},{"id":"fap-38fd11db77be936b","kind":"hospital_web","url":"https://brookshospital.org/wp-content/uploads/2026/08/TT-2026-FAP-Income-Guidelines-BTLC.pdf","title":"Financial Assistance Program Income Guidelines","fetched_on":"2026-10-11","sha256":"38fd11db77be936b12fc156c5674915dfadb9bddd426e74835d2c9ce0b02fa4b","effective_date":null},{"id":"fap-fb0b48f6f068c204","kind":"hospital_web","url":"https://brookshospital.org/wp-content/uploads/2026/08/BMH-LTC-Financial-Assistance-Policy_.pdf","title":"Financial Assistance Policy (English)","fetched_on":"2026-10-11","sha256":"fb0b48f6f068c2042200756e325cfd3661a6add416daf2672492fcc2ee632a0f","effective_date":null},{"id":"fap-a56f54e08ada3411","kind":"hospital_web","url":"https://brookshospital.org/wp-content/uploads/2026/08/BMH-LTC-Financial-Assistance-Policy_Final-Copy-Spanish.pdf","title":"Financial Assistance Policy (Spanish)","fetched_on":"2026-10-11","sha256":"a56f54e08ada3411fe3e1cf2b927d8761a4a70154ce0a18d485ddc4dbe4936cb","effective_date":null},{"id":"fap-01eca1acd3173a1e","kind":"hospital_web","url":"https://brookshospital.org/wp-content/uploads/2026/08/BMH-LTC-Financial-Assistance-Policy-Arabic.pdf","title":"Financial Assistance Policy (Arabic)","fetched_on":"2026-10-11","sha256":"01eca1acd3173a1e93c057c33faecc54eabf237af826db86abdb27bc5017e642","effective_date":null}],"accuracy":null}