KENSINGTON HOSPITAL

"who have family incomes not in excess of 200% of the Federal Poverty Guidelines are eligible to receive Charity Care."

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"This Policy, a Plan Language Summary (“PLS”) of the policy and an application can be found on our website at http://kensingtonhospital.org"

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"Documents to be provided to substantiate income levels & assets include:  If Patient (household) has income: o Copy of most recent IRS Form 1040. (If individual did not file federal income tax return, patient must state so in writing and provide statement that individual is not required to file and reason why) o Copy of the most recent federal income tax return(s) for any individual who has claimed patient as a dependent o Social Security 1099 Forms (if applicable) o Unemployment or workers’ compensation award letters (if applicable) o Pay stubs for the past three months. o If self-employed, Schedule C and/or profit and loss statement  If Patient (household) does not have income: o Letter of (financial) support. The individual providing that support must sign the letter and have the document notarized.  All Patients must provide copies of the most recent statements for the following (if applicable): o Checking and/or Savings Accounts o Stocks, bonds, certificates of deposit (CDs), high yielding interest accounts, or annuities o Any other investments (including real estates) o Health Savings Accounts (HAS), Medical Savings Accounts (MSA), Flexible Spending Arrangements (FSA), or Health Reimbursement Arrangements (HRA)"

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"Application Period: The period during which Kensington Hospital will accept and process FAP Applications. This period begins to run on the date medical care is provided and ends on the 240th day after Kensington Hospital provides the patient with the first billing statement for the care provided."

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"Determinations of Charity Care Eligibility shall be made within 30 days from receipt of completed Financial Assistance Application unless incomplete."

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"If a bill is outstanding 120 days or more, Kensington Hospital’s Controller will review the bill and write it off to Bad Debt."

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES

"You may also contact Kensington Hospital’s Business Office at (215) 426-8100, extension 6505 to request a copy free of charge."

documented · checked 2026-10-13 · Kensington Hospital - Financial Assistance Program

"Kensington Hospital shall publish and post signage and internet notices to advise patients of the availability of Charity Care and Partial Charity Care in the English, and Spanish languages."

documented · checked 2026-10-13 · [PDF] KENSINGTON HOSPITAL POLICIES & PROCEDURES