CROZER CHESTER MEDICAL CENTER

"Eligibility for full Financial Assistance shall be granted for patients who fall between 0 - 200% of the Federal Poverty Income Guidelines as published annually in the Federal Register."

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"Presumptive eligibility may be determined on the basis of individual life circumstances that may include: 1) Homeless - A homeless person is an individual who has no home or place of residence and depends on charity or public assistance; 2) Eligibility for PA or other state Medicaid Assistance Programs (spend down or patient pay amounts); 3) Patient is deceased with no known estate; and 4) Inmates - Patients who are incarcerated may be considered eligible in the event the State or County has made a determination that the State or County is not responsible for charges incurred prior to arraignment."

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"1. If you have income:  Attach a copy of your most recent Federal Income Tax Return (1040, 1040A, 1040EZ If you filed taxes you must supply a copy of the return) 2. If you did not file a federal tax return, you must:  State in writing why you did no file a Federal Income Tax Return on a separate sheet of paper  Send us a copy of the most recent Federal Income Tax Return of anyone who claimed you as a dependent 3. Attach additional proof of household income, if applicable:  1099 forms or award letters: Social Security, Pension/Retirement, Disability, etc….  Unemployment Notice of Final Determination or Workers Compensation  Pay stubs for the last 30 days  If you are self-employed, you must include a schedule C and/or statement of income and expenses 4. If you have no income:  A notarized letter of no income will be required (A CKHS Notary can notarize a letter stating the patient or financially responsible individual has no income) 5. Letter of Denial for Medical Assistance:  Based on initial financial screening, you may need to apply for Medical Assistance and provide a copy of your Letter of Denial before CKHS can approve your application 6. Completed and signed Financial Assistance Program application:  Make sure to complete and include all information that applies to you  Provide a photo ID ie. driver’s license, passport, state ID  Provide additional documents Requested _________________________  __________________________________________________________"

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"Application Period - The Application Period provides an individual 240 days from the date the individual is provided with the first post-discharge billing statements to complete the Financial Assistance Application ( FAP Application)"

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"Approval/rejection of an application will be made within 10 working days of receiving a completed application with all requested information and will be notified via mail."

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"Notification Period- CKHS must notify the individual about the Financial Assistance Policy (FAP) before initiating any extraordinary collection actions (“ECAs”) to obtain payment and refrain from initiating any ECA for at least 120 days from the date the patient is provided the first post-discharge billing statement for care."

documented · checked 2026-10-11 · [PDF] ADMINISTRATIVE POLICY & PROCEDURE ... - Crozer Health

"Call [610-447-2336](tel:6104472336) for assistance."

documented · checked 2026-10-11 · Billing & Payment

"* **Crozer-Chester Medical Center**Phone: [(610) 447-2336](tel:6104472336)  |  Hours: 8 a.m. - 4:30 p.m."

documented · checked 2026-10-11 · Financial Assistance