CAYUGA MEDICAL CENTER AT ITHACA

"A patient whose household income, as determined by the application income worksheet, is equal to or less than 100% of the most recent Federal Poverty Guidelines qualifies for a nominal payment limit as designated by major service category, the rest will be written off."

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Per section 2807-k of the NYDOH regulations, patients can qualify for financial assistance under the following conditions: (a) low income patients with no health insurance; or (b) low income patients who have exhausted their insurance benefits; or (c) low income patients who have an inability to pay co-pays and deductible amounts, at the hospital´s discretion."

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Please attach pay stubs for the most recent 3 month period. Monthly Interest / Dividends: $ _________ Please provide copies of most recent statements Monthly Child Support / Alimony: $ _________ Please provide supporting documentation Monthly Pension / Social Security: $ _________ Please provide copies of most recent statements Monthly Rental / Other Income: $ _________ Please provide supporting documentation"

documented · checked 2026-10-10 · [PDF] Financial Assistance Program Application - Cayuga Medical Center

"All applications are to be submitted to a CHS Financial Counselor, who will make a decision of eligibility within thirty (30) days of receipt of the completed application."

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Extraordinary Collections Actions (ECAs) – including, but not limited to, reporting adverse information to credit bureaus or placing liens on property - cannot commence until at least 121 days after the 1st billing statement and requires that the patient be notified 30 days in advance with a pre-collect letter outlining what ECAs will occur and when (See Appendix H)"

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Please contact Cayuga Medical Center's Patient Billing Office at (607) 274-4400 with any questions."

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Cayuga Medical Center and Cayuga Medical Associates currently provide a translated copy of the FAP brochure in Chinese"

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health

"Entities participating in the Cayuga Health System Financial Assistance Program include: Cayuga Medical Center, Cayuga Medical Associates, & Schuyler Hospital"

documented · checked 2026-10-10 · [PDF] Financial Assistance and Charity Program - Ithaca - Cayuga Health