{"hospital":{"ccn":"450040","name":"COVENANT MEDICAL CENTER","city":"LUBBOCK","state":"TX","zip":"79410","phone":"806-725-4431","ownership":"Voluntary non-profit - Private","website_domain":"covenanthealth.org","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"175","layer":"documented","quote":"If... Then ... Annual gross income is 175% or less of the current FPL guidelines, The patient is determined to be financially indigent, and qualifies for Financial Assistance 100% write-off.","source_id":"fap-7d7a00595db1dc62","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"This includes people who do not have health insurance and are unable to pay their hospital bill, as well as patients who do have insurance but are unable to pay the portion of their bill that insurance does not cover.","source_id":"fap-5d206c16541252e9","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"Other Special Circumstances: Patients who are eligible for FPL-qualified programs such as Medicaid, Medi-Cal, and other government-sponsored low-income assistance programs, are deemed to be indigent.","source_id":"fap-7d7a00595db1dc62","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["proof_of_income","tax_return","pay_stubs","social_security_letter"],"layer":"documented","quote":"□ Provide us information about your family’s gross monthly income (income before taxes and deductions) to include pay stubs, W-2 forms, tax returns, social security awards letters, etc (see financial assistance application Income Section for more examples)","source_id":"application-9ef47672c7568ffa","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"Mail completed application with all documentation to: Covenant Health, Attn: Financial Assistance, P.O. Box 1201, Lubbock, TX 79408."},{"kind":"in_person","detail":"To submit your completed application in person: Provide to a representative in the hospital admitting department."}],"layer":"documented","quote":"Mail completed application with all documentation to: Covenant Health, Attn: Financial Assistance, P.O. Box 1201, Lubbock, TX 79408. Be sure to keep a copy for yourself. To submit your completed application in person: Provide to a representative in the hospital admitting department.","source_id":"application-9ef47672c7568ffa","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":{"value":30,"layer":"documented","quote":"We will notify you of the final determination of eligibility and appeal rights, if applicable, within 30 days of receiving a complete financial assistance application, including documentation of income.","source_id":"application-9ef47672c7568ffa","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"(806) 725-5773","layer":"documented","quote":"By Mail: Call a financial counselor at (806) 725-5773 to request an application be mailed to you.","source_id":"fap-5d206c16541252e9","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"hours":null,"languages":{"value":["English","Spanish"],"layer":"documented","quote":"In addition to English, this brochure, the Financial Assistance Policy and the Covenant Health Financial Assistance Application form are available in other languages, including Spanish.","source_id":"fap-5d206c16541252e9","checked_on":"2026-10-11","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Covenant Medical Center","Covenant Hospital Levelland","Covenant Hospital Plainview","Covenant Children’s Hospital","Covenant Specialty Hospital"],"layer":"documented","quote":"Covenant Medical Center 3615 19th St., Lubbock, TX 79410 covenanthealth.org Covenant Hospital Levelland 1900 College Ave., Levelland, TX 79336 covenanthealth.org Covenant Hospital Plainview 2601 Dimmit Rd., Plainview, TX 79072 covenanthealth.org Covenant Children’s Hospital 4015 22nd Pl., Lubbock, TX 79410 covenantchildrens.org Covenant Specialty Hospital 3815 20th St. Lubbock, TX 79410 covenanthealth.org","source_id":"fap-5d206c16541252e9","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-5d206c16541252e9","kind":"hospital_web","url":"https://grace.covenanthealth.org/-/media/project/psjh/covenant/for-patients/pdfs/financial-assistance-brochure-sjh-texas-english-.pdf?rev=354f714cdd8d42f88a02bb6a7f71b0e7&hash=669488BAF5FC250DE90B88A41EA75E55","title":"Financial Assistance Program - Covenant Health","fetched_on":"2026-10-11","sha256":"5d206c16541252e91c67356191a27279fe5ef13eecddaa9b512d262545984819","effective_date":null},{"id":"application-9ef47672c7568ffa","kind":"hospital_web","url":"https://grace.covenanthealth.org/-/media/project/psjh/covenant/for-patients/pdfs/financial-assistance-application-sjh-txenglish.pdf?rev=f9c5996a18fd4347a01996553fc2f5ce&hash=B99972C263343AF2031C6ED8A0A67A1B","title":"Charity Care/Financial Assistance Application Form Instructions","fetched_on":"2026-10-11","sha256":"9ef47672c7568ffabbef4ae800e5a39c811929ca828b5f5430b19be8bf8eba66","effective_date":null},{"id":"billing-e917ff286afa24b8","kind":"hospital_web","url":"https://www.covenanthealth.org/patients-and-visitors/for-patients/billing-and-payments/online-bill-pay","title":"Find Billing Support That's Right for You","fetched_on":"2026-10-11","sha256":"e917ff286afa24b8e54ada716f70403c5c1cfa034fec5797fde58e917e232c8c","effective_date":null},{"id":"fap-7d7a00595db1dc62","kind":"hospital_web","url":"https://grace.covenanthealth.org/-/media/project/psjh/covenant/for-patients/pdfs/financialassistancepolicysjhtxenglish1252020.pdf?rev=d7657f332a5142e084df981f66631529&hash=FB36FDD07EEE435BFFCDE7D86FBB848B","title":"SJH Financial Assistance (Charity Care) Policy - Grace Clinic","fetched_on":"2026-10-11","sha256":"7d7a00595db1dc620a9078c2cadc0dcf7d7b9e7311276d9feee42626ea9e9d7f","effective_date":null},{"id":"billing-9a2fb58c0479ee47","kind":"hospital_web","url":"https://www.covenanthealth.org/billing-support/help-paying-your-bill","title":"Financial Assistance","fetched_on":"2026-10-11","sha256":"9a2fb58c0479ee47a923c6bc0010f79db47292b82d3250f1be51b8428e2ca0d9","effective_date":null},{"id":"billing-bc23a3669c6f0c73","kind":"hospital_web","url":"https://www.covenanthealth.org/billing-support","title":"Online Bill Pay & Financial Assistance","fetched_on":"2026-10-11","sha256":"bc23a3669c6f0c73af3bb619a3d3074bed802a93d22e7be813927900f05acf30","effective_date":null}],"accuracy":null}