MEDINA HOSPITAL

"• If your annual family income is up to 250% of the FPG, you will receive free care"

documented · checked 2026-10-14 · Summary of Financial Assistance

"Even if you have insurance, as long as you meet our income criteria, you will be eligible for financial assistance if: your in-network insurance does not provide coverage for the medically necessary services you are seeking or you have exhausted your lifetime maximum insurance benefits."

documented · checked 2026-10-14 · Summary of Financial Assistance

"Provide income for yourself, your spouse and all other family members (if applicable). Income Source Total for 3 Months Prior to Service Total for 12 Months Prior to Service Wages/Self Employment $ $ Social Security $ $ Pension, Dividends, Interest, Rental Income $ $ Unemployment, Workers’ Compensation $ $ Child Support (only if the patient is the intended recipient) $ $ Other $ $"

documented · checked 2026-10-14 · Summary of Financial Assistance

"If you call Customer Service at 866.621.6385 or ask a Patient Financial Advocate, we will mail you a copy of our Financial Assistance Policy, plain language summary and application form free of charge."

documented · checked 2026-10-14 · Summary of Financial Assistance

"Copies of our Financial Assistance Policy, Application Form, and this Summary are available in English, Arabic, Spanish, Russ Копии Политики оказания финансовой помощи, бланка заявки и aitiano y creole."

documented · checked 2026-10-14 · Summary of Financial Assistance