{"hospital":{"ccn":"330238","name":"NICHOLAS H NOYES MEMORIAL HOSPITAL","city":"DANSVILLE","state":"NY","zip":"14437","phone":"585-335-6001","ownership":"Voluntary non-profit - Private","website_domain":"rochester.edu","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"A 100% discount is available to individuals and families with annual incomes at or below 200% of the FPG.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":{"value":[{"min_fpl_exclusive":"200","max_fpl_inclusive":"300","discount_percent":90},{"min_fpl_exclusive":"300","max_fpl_inclusive":"400","discount_percent":80}],"layer":"documented","quote":"Discount Gross Income as % of Federal Poverty Level\n100% UP TO 200%\n90% BETWEEN 201 – 300%\n80% BETWEEN 301 - 400%\n0% OVER 401%","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"This Financial Assistance Policy has been developed to help patients who are either uninsured or underinsured, after exhausting all efforts to apply for and/or obtain insurance coverage.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"Note: Patients are also considered presumptively eligible for 100% financial assistance if they are eligible for Medicaid and have outstanding balances prior to being covered by Medicaid.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["social_security_letter"],"layer":"documented","quote":"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).","source_id":"application-2843ab697498612d","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Please submit your completed application by mail, email or fax; UR Medicine Affiliate Billing Office 73 Buffalo St, suite 100 Canandaigua, NY 14424 Attn: Financial Assistance"},{"kind":"email","detail":"Email: URMCAffiliateFinancialAssistance@URMC.Rochester.edu"},{"kind":"fax","detail":"Fax: 585/340-4018"}],"layer":"documented","quote":"Please submit your completed application by mail, email or fax; UR Medicine Affiliate Billing Office 73 Buffalo St, suite 100 Canandaigua, NY 14424 Attn: Financial Assistance Email: URMCAffiliateFinancialAssistance@URMC.Rochester.edu Fax: 585/340-4018","source_id":"application-2843ab697498612d","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"Fully completed Financial Assistance applications are processed timely, and determinations are communicated to the patients within 30 days.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","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-2843ab697498612d","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"(585) 396-6515","layer":"documented","quote":"until 4:30 p.m.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"hours":{"value":"Monday through Friday from 8:00 a.m. until 4:30 p.m.","layer":"documented","quote":"until 4:30 p.m.","source_id":"fap-84c5a206030d3359","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-84c5a206030d3359","kind":"hospital_web","url":"https://www.urmc.rochester.edu/getmedia/dfa7feb9-c6a7-427e-b030-a69cce3a3485/noyes-financial-assistance-policy.pdf","title":"Noyes Health Financial Assistance Policy - UR Medicine","fetched_on":"2026-10-14","sha256":"84c5a206030d335905a1c0206f20fff1054eb944b5c65a709dead855239e9a53","effective_date":null},{"id":"application-2843ab697498612d","kind":"hospital_web","url":"https://www.urmc.rochester.edu/getmedia/9804e29d-affe-44f1-bcb6-e16961a58442/financial-assistance-affiliate-sliding-fee-application.pdf","title":"[PDF] NYS Uniform Hospital Financial Assistance Application | UR Medicine","fetched_on":"2026-10-14","sha256":"2843ab697498612dac895c304d0950dd4e1d08b94da374d7cb2c578daef3d8f4","effective_date":null},{"id":"summary-6196fb2e3da1ea90","kind":"hospital_web","url":"https://www.urmc.rochester.edu/getmedia/f9a2c649-7d34-4adc-8ce8-f12f2f6e3f34/affiliate-financial-assistance-summary.pdf","title":"affiliate-financial-assistance-summary.pdf","fetched_on":"2026-10-14","sha256":"6196fb2e3da1ea901b4b1bfdd14b731a0e87bb6e24781561f3593eaaac345e36","effective_date":null},{"id":"fap-19fcc3df0072569b","kind":"hospital_web","url":"https://www.urmc.rochester.edu/getmedia/0bc830ce-7df0-45ca-a59c-e1d40dd0345d/pay-bill-financial-assistance-policy.pdf","title":"Financial Assistance Policy","fetched_on":"2026-10-14","sha256":"19fcc3df0072569b133ec07b4bff02f3a03c2d54491d3d50a154f29f6be9c42e","effective_date":null}],"accuracy":null}