{"hospital":{"ccn":"330233","name":"BROOKDALE HOSPITAL MEDICAL CENTER","city":"BROOKLYN","state":"NY","zip":"11212","phone":"718-240-5966","ownership":"Voluntary non-profit - Private","website_domain":"tbh.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"If your family income is less than or equal to 200% of the FPG, you may qualify for free hospital or hospital clinic care.","source_id":"billing-84ed13db3aa7e90e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"You may be eligible if you have no health insurance (uninsured) or if you have health insurance with high out-of-pocket costs that you are not able to pay (underinsured).","source_id":"billing-84ed13db3aa7e90e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":{"value":"https://www.tbh.org/sites/default/files/2026-07/2026-tbhc-financial-assistance-application-package.docx","layer":"documented","quote":"[TBHC Financial Assistance Application Package](https://www.tbh.org/sites/default/files/2026-07/2026-tbhc-financial-assistance-application-package.docx)","source_id":"billing-84ed13db3aa7e90e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["proof_of_income","social_security_letter","tax_return","pay_stubs"],"layer":"documented","quote":"You may also provide the Eligibility determination page from the NY State of Health Marketplace. If you have this document, you do not have to provide any other income information listed below to the hospital.\n\n**If Household****Receives:****Amount****per****Month:****Applicant****May****Provide:**\nWages$Please provide one Paycheck Stub, or Letter from Employer on company letterhead,signed and dated, or most recently filed income tax return.\nSocial Security Payment$Copy of award letter/certificate, or correspondence from the U.S. Social Security Administration, or annual benefit letter.To request a copy of your Social Security benefit letter, call 1-800-772-1213 or visit [www.ssa.gov.](http://www.ssa.gov/)\nUnemployment Compensation$Copy of award letter/certificate, or monthly benefit statement from NYS Department of Labor,or Copy of Direct Payment Card with printout, or Correspondence from the NYS Department of Labor, or Printout of recipient’s account information from the NYS Department of Labor’s website [(www.labor.state.ny.us).](http://www.labor.state.ny.us/)\nDisability Payment$Copy of award letter/certificate, or correspondence from Social Security Administration,or copy of annual benefit letter.To request a copy of your benefit letter, call 1-800-772-1213 or visit [www.ssa.gov.](http://www.ssa.gov/)\nWorkers Compensation$Copy of Award Letter or Check stub.\nAlimony/Child Support$Copy of court order,or 3 months of cashed checks/receipts.\nDividends/Interest$Quarterly dividend statements or 1 month statements.\nOther$Letter stating the amount of non-wage earnings (if any),such as rental income,cash for odd jobs,etc.\nNo Income$0 Signed statement of no income.","source_id":"application-fa1ad855d98d6d4e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Mailing address:\n\nThe Brooklyn Hospital Center\nAttn: Financial Counselors Unit, 2nd Floor\n121 DeKalb Avenue, Brooklyn, NY 11201"},{"kind":"in_person","detail":"At any of the main hospital’s registration desks and any of the hospital clinics"},{"kind":"phone","detail":"By contacting the Financial Counselors Unit at 718-250-8080"},{"kind":"portal","detail":"Online via the hospital’s website at: https://www.tbh.org/visitor-information/billing/financial-assistance"}],"layer":"documented","quote":"Submit a complete financial assistance application with all required documentation via mail, or by working with one of our Financial Counselors in person or via phone. You can get an application in any of the following ways:\n\n*   Online via the hospital’s website at: [https://www.tbh.org/visitor-information/billing/financial-assistance](https://www.tbh.org/visitor-information/billing/financial-assistance)\n*   At any of the main hospital’s registration desks and any of the hospital clinics\n*   By contacting the Financial Counselors Unit at 718-250-8080\n*   Mailing address:\n\nThe Brooklyn Hospital Center\nAttn: Financial Counselors Unit, 2nd Floor\n121 DeKalb Avenue, Brooklyn, NY 11201","source_id":"billing-84ed13db3aa7e90e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"Once the patient has submitted an application the patient may disregard all bills until a determination has been made on the application. A decision will be made within 30 days of receipt of completed application.","source_id":"fap-dd71fd8d6a9e32c3","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":{"value":180,"layer":"documented","quote":"*   Hospitals cannot send unpaid bills to a collection agency for at least 180 days after your first bill.","source_id":"application-fa1ad855d98d6d4e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"718-250-8080","layer":"documented","quote":"By contacting the Financial Counselors Unit at 718-250-8080","source_id":"billing-84ed13db3aa7e90e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"billing-84ed13db3aa7e90e","kind":"hospital_web","url":"https://www.tbh.org/visitor-information/billing/financial-assistance","title":"Financial Assistance | The Brooklyn Hospital Center","fetched_on":"2026-10-10","sha256":"84ed13db3aa7e90e20e043d4010b3ed0656ec93a6bee7072e292089fee4cc12a","effective_date":null},{"id":"billing-9b499c42abf7aa7c","kind":"hospital_web","url":"http://www.tbh.org/visitor-information/billing/financial-assistance","title":"Financial Assistance | The Brooklyn Hospital Center","fetched_on":"2026-10-10","sha256":"9b499c42abf7aa7c0e4d3c3b65182d93083b6a25113469007f6eea0f9649a51f","effective_date":null},{"id":"billing-5ccfb90654037a32","kind":"hospital_web","url":"https://www.tbh.org/visitor-information/billing","title":"Billing, Paying Your Bill and Billing Records | The Brooklyn Hospital Center","fetched_on":"2026-10-10","sha256":"5ccfb90654037a32659704fa2230ff37fb24e4951320919d81f508055fe88672","effective_date":null},{"id":"billing-104b3262bb743d6f","kind":"hospital_web","url":"https://www.tbh.org/visitor-information/billing/faq","title":"Billing and Collections Policy","fetched_on":"2026-10-10","sha256":"104b3262bb743d6fc4fc143535f55bc9ccbe0bf62f79d88c70c0c356231b1225","effective_date":null},{"id":"fap-dd71fd8d6a9e32c3","kind":"hospital_web","url":"https://www.tbh.org/sites/default/files/2026-07/2026-tbhc-financial-assistance-policy.docx","title":"TBHC Financial Assistance Policy","fetched_on":"2026-10-10","sha256":"dd71fd8d6a9e32c326134ab5518a4746b0ac9b9115e50e8747dc375be7747692","effective_date":null},{"id":"application-fa1ad855d98d6d4e","kind":"hospital_web","url":"https://www.tbh.org/sites/default/files/2026-07/2026-tbhc-financial-assistance-application-package.docx","title":"TBHC Financial Assistance Application Package","fetched_on":"2026-10-10","sha256":"fa1ad855d98d6d4e30393c0d77969a5a43da0b491a2085391eb0cff469adf5a8","effective_date":null},{"id":"summary-21b34a3b09c97e60","kind":"hospital_web","url":"https://www.tbh.org/sites/default/files/2026-07/2026-tbhc-fap-plain-language-summary.docx","title":"TBHC FAP Plain Language Summary","fetched_on":"2026-10-10","sha256":"21b34a3b09c97e60186f41f443e21241d3dceb2826e7fcce71405aafbef22b91","effective_date":null}],"accuracy":null}