LifeBridge Health Financial Assistance
Do you need help paying your hospital bill?
Financial hardship doesn't have to be an obstacle to your care. LifeBridge Health hospitals (Sinai Hospital of
Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Hospital and Nursing Center, and Grace Medical
Center) can provide assistance, including discounts, to financially disadvantaged patients (including the uninsured
or underinsured) who qualify.
Eligibility
Patients and families with an annual income up to 300% of the Federal Poverty Level may qualify for discounts up to
100% of their hospital bill.
For example, you may qualify if your income is lower than the amounts applicable to your family size in the table
below (for each additional person, add $1,180 monthly or $14,160 annually):
|
|
Uninsured & Underinsured
100% Discount |
| Family
Size |
Earnings
Period |
up to 300% FPL |
| 1 |
Monthly |
$3,397.50 |
| Annual |
$40,770.00 |
| 2 |
Monthly |
$4,577.50 |
| Annual |
$54,930.00 |
| 3 |
Monthly |
$5,757.50 |
| Annual |
$69,090.00 |
| 4 |
Monthly |
$6,937.50
|
| Annual |
$83,250.00 |
| 5 |
Monthly |
$8,117.50 |
| Annual |
$97,410.00 |
Which Providers and Hospitals Participate?
Each LifeBridge Health hospital participates in the
Financial Assistance Program. However, charges for
physician services are billed separately and may not
be covered by our financial assistance policy. For more information about services and providers covered under our policy,
please visit Financial Assistance Policy.
How to apply
Applying is simple. You can request a financial
assistance application by calling Customer Service at (800)788-6995, visiting the
Customer Service area
at the hospital where you received care, or asking a
registration representative. You can personally submit
your completed application to Customer Service or
a registration representative, fax it to (401)601-4031 or mail it to:
LifeBridge Health,
Attn: Financial Assistance Representative,
2401 West Belvedere Avenue
Baltimore, Maryland 21215
Please note that additional documentation may be
requested in order to help us make a determination. Most
determinations are completed within 14 business days.
You will receive either a letter by mail or a telephone
call about your eligibility.
For additional information, call
Customer Service at 1-800-788-6995
More Information:
Plain Language Summary – For a summary of the Financial Assistance Policy, click here for English,
Spanish, Russian, or French.
Financial Assistance Application – Download a Financial Assistance Application. Click here for English,
Spanish,
Russian,
or French.
Financial Assistance Policy – For more information about the Financial Assistance program, click here for
the policy in English, Spanish, Russian, or French.
Billing & Collections Policy - For more information click here for the policy in English,
Spanish, Russian, or French.
Services and Providers Covered Under the Financial Assistance Policy – ClickHere.