{"hospital":{"ccn":"331301","name":"CUBA MEMORIAL HOSPITAL, INC","city":"CUBA","state":"NY","zip":"14727","phone":"585-961-2000","ownership":"Voluntary non-profit - Private","website_domain":"cubamemorialhospital.com","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"FPL LEVEL 200% 300% 400% 1 $30,120 $45,180 $60,240 2 $40,880 $61,320 $81,760 3 $51,640 $77,460 $103,280 4 $62,400 $93,600 $124,800 5 $73,160 $109,740 $149,320 6 $83,920 $125,880 $167,840 7 $94,680 $142,020 $189,360 8 $105,440 $158,160 $210,880 Each add’l person add: $10,760 $16,140 $21,520 Discount on Charges 100% 90% 80% Patient Share 0% 10% 20% Form #:","source_id":"summary-9991da80844a93f0","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":null,"asset_test":null,"residency":null,"insured_patients_covered":null,"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":"Cuba Memorial Hospital 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-9991da80844a93f0","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"You will receive a letter from Cuba Memorial Hospital (usually within 30 days after completion and submission of documentation) telling you if you have been approved and the level of discount received","source_id":"summary-9991da80844a93f0","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":"716-375-6080","layer":"documented","quote":"Please contact our Facilitated Enroller at 716-375-6080 for free confidential assistance.","source_id":"summary-9991da80844a93f0","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"summary-9991da80844a93f0","kind":"hospital_web","url":"https://www.cubamemorialhospital.com/docs/CMH_FA_Summary.pdf","title":"[PDF] Financial Assistance Summary - Cuba Memorial Hospital","fetched_on":"2026-10-11","sha256":"9991da80844a93f055182f2b9869b53a8759bbfbc6ceabc53e4a07a24b966e8c","effective_date":null},{"id":"billing-e6adacb5f81c33d6","kind":"hospital_web","url":"https://cubamemorialhospital.com/billpay.html","title":"Pay Your Bill Online – Cuba Memorial Hospital Billing & Financial Assistance","fetched_on":"2026-10-11","sha256":"e6adacb5f81c33d6ed98450e2b7d32346622f595f782e7a06392732f5f9db1b8","effective_date":null}],"accuracy":null}