{"hospital":{"ccn":"360091","name":"MEDINA HOSPITAL","city":"MEDINA","state":"OH","zip":"44256","phone":"330-725-1000","ownership":"Voluntary non-profit - Private","website_domain":"clevelandclinic.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"250","layer":"documented","quote":"• If your annual family income is up to 250% of the FPG, you will receive free care","source_id":"application-68e4da3557adef59","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"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.","source_id":"application-68e4da3557adef59","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"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"],"layer":"documented","quote":"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 $ $","source_id":"application-68e4da3557adef59","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":null,"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"866.621.6385","layer":"documented","quote":"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.","source_id":"application-68e4da3557adef59","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"hours":null,"languages":{"value":["English","Arabic","Spanish","Russian","Ukrainian","Nepali","Creole"],"layer":"documented","quote":"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.","source_id":"application-68e4da3557adef59","checked_on":"2026-10-14","confidence":1.0,"support_count":0}},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"application-68e4da3557adef59","kind":"hospital_web","url":"https://my.clevelandclinic.org/-/scassets/files/org/patients-visitors/billing/financial-assistance/1-financial-assistance-program-summary-application.pdf?la=en","title":"Summary of Financial Assistance","fetched_on":"2026-10-14","sha256":"68e4da3557adef59d88035303b59f0ae7307376f0ed8669e8cd1188d1a78630b","effective_date":null},{"id":"application-dca28d8b7c7159a8","kind":"hospital_web","url":"https://my.clevelandclinic.org/-/scassets/files/org/about/financial-statements/2023-ccf-form-990-group.pdf?la=en","title":"2023-ccf-form-990-group.pdf","fetched_on":"2026-10-14","sha256":"dca28d8b7c7159a8bf8c6293d3422565d235713c6c0014c431f183ed62a19776","effective_date":null}],"accuracy":null}