Patient Financial Assistance Program
John Muir Health funds a patient assistance program that may cover all or part of your hospital bills. Your eligibility is based partly on your household income. To qualify, you must meet one of the following sets of criteria:
A. You must have no insurance or other third party that will pay all or part of your hospital bill. You also must have a family income at or below 400% of the Federal Poverty Guidelines based on members of the household.
or
B. You have some form of third-party insurance coverage, but you do not receive a discounted rate from John Muir Health because of that coverage. Also, your annual out-of-pocket costs for medical expenses must have exceeded the lesser of 10% of your household family income in the past 12 months of application or your current family income and you must have a family income at or below 400% of the Federal Poverty Guidelines based on members of the household.
How to Apply
To qualify, you will need to complete the Patient Financial Assistance Application Form and submit the required documents, including:
- Tax return for the year in which the patient was first billed; or 12 months prior to when the patient was first billed
or
- Pay stubs within a 6 month period before or after the patient is first billed by the hospital for each family member
We may request additional documentation, depending on your circumstances. If you have questions, please call our Patient Financial Assistance team at (925) 947-3336, Monday - Friday, between 8:30 AM – 4:30 PM.
Appeals
If you believe your application was not properly considered, you may send us a written request for reconsideration. Please send it to:
Director of Single Business Office
John Muir Health
5003 Commercial Circle
Concord, CA 94520
Hospital Bill Complaint Program
The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill.
If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.
Visit HospitalBillComplaint.hcai.ca.gov/ for more information and to file a complaint.
Patient Financial Assistance Resources
Patient Financial Assistance Brochure |
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Patient Financial Assistance Application | |
Patient Financial Assistance Plain Language Summary | |
Patient Financial Assistance Plan Policy | |
Self Pay Bad Debt Collections Policy |