{"hospital":{"ccn":"390037","name":"HERITAGE VALLEY SEWICKLEY","city":"SEWICKLEY","state":"PA","zip":"15143","phone":"412-741-6600","ownership":"Voluntary non-profit - Private","website_domain":"heritagevalley.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"If the patient and/or guarantor’s household income is at or below 200% of the Federal Poverty Level (FPL) Guidelines, then 100% of the balance for which the patient is still responsible will be forgiven by HVHS.","source_id":"fap-a7cc3e246c646725","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"discount_tiers":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","social_security_letter","tax_return","pay_stubs","bank_statements","medicaid_denial"],"layer":"documented","quote":"**Include proof of ALL income, assets, and expenses:**\n\n**Income (money received):**\n\n    *   IRS 1040 tax return\n\n    *   Pay stubs (last 30 days)\n\n    *   Social Security, Unemployment, or Workers’ Comp letters\n\n    *   If self-employed: full tax return or other proof of income\n\n**Assets (money in accounts):**\n\n    *   Checking/savings account statements\n\n    *   Credit Union or CD statements\n\n**Expenses (bills paid):**\n\n    *   Copies of current bills or statements\n\n\n1.   **If hospitalized:** Applicant is requested to apply for Medical Assistance and include proof of denial.\n\n2.   **If the patient is deceased:** Include a death certificate and estate status letter.","source_id":"application-1a16b8df53a0ee6b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Mail completed application and documents to: Heritage Valley Health System Attn: Charity Care 200 Ohio River Blvd Baden, PA 15005"}],"layer":"documented","quote":"3.   **Mail completed application and documents to:** \n Heritage Valley Health System \n Attn: Charity Care \n 200 Ohio River Blvd \n Baden, PA 15005","source_id":"application-1a16b8df53a0ee6b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Applications must be received within 240 days from the date that HVHS first sent a post-discharge billing statement to the patient (the “application period”).","source_id":"fap-a7cc3e246c646725","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":{"value":120,"layer":"documented","quote":"During the period that extends 120 days past the date of the first post-discharge billing statement (120-Day Period), HVHS and the patient will endeavor to resolve the patient’s obligation, without the use of Extraordinary Collection Actions (ECAs), such as credit reporting, lawsuits, or debt sales.","source_id":"fap-a7cc3e246c646725","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"412-749-4200 or 724-773-5681","layer":"documented","quote":"Alternatively, you may call our office at 412-749-4200 or 724-773-5681 to have the application mailed to you.","source_id":"fap-a7cc3e246c646725","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["Heritage Valley Beaver","Heritage Valley Sewickley"],"layer":"documented","quote":"This program applies to medical services rendered at **Heritage Valley Beaver** or **Heritage Valley Sewickley**, and does not include any other medical bills I may have such as physician services, radiology, ambulance, etc.","source_id":"application-1a16b8df53a0ee6b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-a7cc3e246c646725","kind":"hospital_web","url":"https://www.heritagevalley.org/financial-assistance-policy","title":"Financial Assistance Policy - Heritage Valley Health System","fetched_on":"2026-10-13","sha256":"a7cc3e246c6467258d674fb957ec01024d71e4884a9989156f41b787d2a0a5ba","effective_date":null},{"id":"billing-4db912befcda1ac4","kind":"hospital_web","url":"https://www.heritagevalley.org/patient-visitor-resources/billing-payments/financial-assistance","title":"Financial Assistance - Heritage Valley Health System","fetched_on":"2026-10-13","sha256":"4db912befcda1ac4ab743885f0fdad31a8faf4a0f0be0ed8df78bcc28a16ca3a","effective_date":null},{"id":"billing-d0b053698dd35475","kind":"hospital_web","url":"https://www.heritagevalley.org/patient-visitor-resources/billing-payments","title":"Billing & Payments - Heritage Valley Health System","fetched_on":"2026-10-13","sha256":"d0b053698dd3547515874ecca6e4c8198c7c64bf936d658d65d341ba3c829db5","effective_date":null},{"id":"fap-56ca37b5e907da4b","kind":"hospital_web","url":"https://www.heritagevalley.org/wp-content/uploads/2025/12/HVHS-Financial-Assistance-Policy-NM.pdf","title":"*Click here for printable copy*","fetched_on":"2026-10-13","sha256":"56ca37b5e907da4b7047b055a4f46babeb1a89aef40b8107b7e4c4ad9e3b0b08","effective_date":null},{"id":"application-1a16b8df53a0ee6b","kind":"hospital_web","url":"https://www.heritagevalley.org/wp-content/uploads/2026/07/2026-Charity-Process-application-document.docx","title":"Financial Assistance Application","fetched_on":"2026-10-13","sha256":"1a16b8df53a0ee6bafd9f4e73008696a474bb300f7ab302e3ecc73d263ce8ba7","effective_date":null}],"accuracy":null}