{"hospital":{"ccn":"450755","name":"COVENANT HOSPITAL LEVELLAND","city":"LEVELLAND","state":"TX","zip":"79336","phone":"806-894-4963","ownership":"Voluntary non-profit - Private","website_domain":"providence.org","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"If... Then ... Annual family income, adjusted for family size, is at or below 200% of the current FPL guidelines, The patient is determined to be financially indigent and qualifies for financial assistance 100% write-off on patient responsibility amounts for Eligible Services.","source_id":"fap-e187f4f7be7672f4","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":"Financial assistance is available to both uninsured and insured patients if they meet the requirements of this policy.","source_id":"fap-e187f4f7be7672f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Supplemental Nutrition Assistance Program (SNAP)"],"layer":"documented","quote":"• Denied inpatient stays • Denied inpatient days of care • Non-covered services • Prior Authorization Request Denials • Denials due to restricted coverage For patients who participate in state funded FPL-qualified public assistance programs (e.g., Supplemental Nutrition Assistance Program (SNAP);","source_id":"fap-e187f4f7be7672f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":null,"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":""},{"kind":"in_person","detail":""},{"kind":"portal","detail":"www.providence.org/financialhelp"}],"layer":"documented","quote":"Patients may request and submit a Financial Assistance Application, which is free of charge and available at the SJH facility, or by the following means: advising patient financial services staff at or prior to the time of discharge that assistance is requested, by mail, or by visiting www.providence.org/financialhelp","source_id":"fap-e187f4f7be7672f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"The FAP-Eligible Time Period for (i) hospital services is the 240-day period of time; and (ii) clinic services is the 90-day period, in each case that a patient has to submit a Financial Assistance Application to SJH. The timing begins on the date the first post-discharge billing statement is provided to the patient.","source_id":"fap-e187f4f7be7672f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days":{"value":30,"layer":"documented","quote":"Patients will receive notification of FAP eligibility determination within 30 days of submission of the completed Financial Assistance Application and necessary documentation.","source_id":"fap-e187f4f7be7672f4","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":null,"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-e187f4f7be7672f4","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf?rev=47cb071f6cf4468091f26f4c1cd92501","title":"SJH Texas Financial Assistance (Charity Care) Policy","fetched_on":"2026-10-11","sha256":"e187f4f7be7672f4644f0f27db03ce9408d81f520a1682cf832f76e773468143","effective_date":null},{"id":"summary-3ff5132e9bf794a7","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf?rev=c28913a94c9c4f4993f53026d195638f","title":"Financial Assistance Policy – Plain Language Summary","fetched_on":"2026-10-11","sha256":"3ff5132e9bf794a76831e0336ddea4ac3b0befd08810b08022ffc26168900e3b","effective_date":null},{"id":"summary-3ff5132e9bf794a7","kind":"hospital_web","url":"https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf?rev=230236cd813d4b49a7b717784695709f","title":"[PDF] Financial Assistance Policy – Plain Language Summary - Texas","fetched_on":"2026-10-11","sha256":"3ff5132e9bf794a76831e0336ddea4ac3b0befd08810b08022ffc26168900e3b","effective_date":null}],"accuracy":null}