COVENANT HOSPITAL PLAINVIEW
PLAINVIEW, TX · version 3 · published · JSON
eligibility.free_care_max_fpl175% of the federal poverty level"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."
documented · checked 2026-10-11 · SJH Financial Assistance (Charity Care) Policy - Grace Clinic
eligibility.insured_patients_coveredYes"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."
documented · checked 2026-10-11 · Financial Assistance Program - Covenant Health
programs.presumptiveMedicaid"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."
documented · checked 2026-10-11 · SJH Financial Assistance (Charity Care) Policy - Grace Clinic
apply.documents_requiredProof of incomeTax return
Pay stubs
Social Security letter
"□ 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)"
documented · checked 2026-10-11 · Charity Care/Financial Assistance Application Form Instructions
apply.submit_methodsMail: Mail completed application with all documentation to: Covenant Health, Attn: Financial Assistance, P.O. Box 1201, Lubbock, TX 79408.In person: To submit your completed application in person: Provide to a representative in the hospital admitting department.
"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."
documented · checked 2026-10-11 · Charity Care/Financial Assistance Application Form Instructions
apply.decision_days30 days"Within 30 days after we receive your completed application and documentation, we will notify you if you qualify for assistance."
documented · checked 2026-10-11 · Charity Care/Financial Assistance Application Form Instructions
contacts.phone(806) 725-5773"By Mail: Call a financial counselor at (806) 725-5773 to request an application be mailed to you."
documented · checked 2026-10-11 · Financial Assistance Program - Covenant Health
contacts.languagesEnglishSpanish
"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."
documented · checked 2026-10-11 · Financial Assistance Program - Covenant Health
coverage.facilitiesCovenant Hospital Plainview"Covenant Hospital Plainview 2601 Dimmit Rd., Plainview, TX 79072 covenanthealth.org"
documented · checked 2026-10-11 · Financial Assistance Program - Covenant Health
Sources
Financial Assistance Program - Covenant Health — fetched 2026-10-11
Charity Care/Financial Assistance Application Form Instructions — fetched 2026-10-11
Get a Price Estimate | Providence — fetched 2026-10-11
SJH Financial Assistance (Charity Care) Policy - Grace Clinic — fetched 2026-10-11
Learn More About Financial Assistance — fetched 2026-10-11