LifeBridge Health Financial Assistance
Do you need help paying your hospital bill?
Carroll Hospital, Grace Medical Center, Northwest Hospital, and Sinai Hospital proudly offers financial
assistance or discounts to those individuals who are having financial difficulty and qualify. Patients
should not have to choose between paying their bills and receiving care at Carroll Hospital, Grace
Medicaid Center, Levindale Hebrew Geriatric Center, Northwest Hospital, or Sinai Hospital. The
application is simple to complete and easy to apply.
Eligibility
Eligibility is based on the individual’s annual income and family size. Patients and families with annual
income below 300% of the U.S. Government’s Federal Poverty Level may qualify for discounts up to
100% of their hospital bill. Use the below table to match your annual income and family size. If your
income is below the amount listed in the table, you may qualify. Complete an application or contact our
Customer Service department for more information at (800)788-6995.
|
|
|
Uninsured & Underinsured
100% Discount
|
|
Family
Size
|
Earnings
Period
|
<300%
|
|
1
|
Monthly
|
$3,190
|
|
Annual |
$38,280
|
|
2
|
Monthly
|
$4,310 |
| Annual |
$51,720
|
|
3
|
Monthly
|
$5,430 |
|
Annual |
$65,160
|
|
4
|
Monthly
|
$6,550
|
|
Annual
|
$78,600
|
|
5
|
Monthly
|
$7,670
|
|
Annual
|
$92,040
|
Note: For each additional person add $1,120 monthly or $13,440 annually
How to apply
The application process is easy. Simply click here for a Financial Assistance application or request an
application by calling Customer Service at (800)788-6995, visiting a Customer Service location at Carroll
Hospital, Grace Medicaid Center, Northwest Hospital, and Sinai Hospital or asking a Registration
Representative. Return a completed application to Customer Service or any Registration
Representative. Application can also be faxed to (401)601-4031 or mailed to:
LifeBridge Health,
Attn: Financial Assistance Representative,
2401 West Belvedere Avenue
Baltimore, Maryland 21215
Additional documentation may be requested to make a determination. Most determinations are
completed within 14 business days. You will receive a letter by mail or a telephone call about your
eligibility.
Which Providers and Hospitals Participate?
Each hospital participates in the Financial Assistance program. These hospitals include Carroll Hospital,
Grace Medical Center, Levindale Hebrew Geriatric Center and Hospital, Northwest Hospital and Sinai
Hospital. Charges for physician services are billed separately and may not be covered by the Financial
Assistance Policy. For a complete list of participating providers, please see Services and Providers
Covered Under the Financial Assistance Policy.
More Information:
Plain Language Summary – For a summary of the Financial Assistance Policy, click here for English,
Spanish, Russian.
Financial Assistance Policy – For more information about the Financial Assistance program, click here for
the policy in English, Spanish, Russian.
Financial Assistance Application – Download a Financial Assistance Application. Click here for English,
Spanish, Russian.
Services and Providers Covered Under the Financial Assistance Policy – For a list of participating
locations and providers, click here for English, Spanish, Russian.