Auburn Community Hospital recognizes that there are times when patients in need of medically necessary care will have difficulty paying for the services provided. Auburn Community Hospital’s financial assistance program provides discounts to qualifying individuals based on your income. In addition, we can help you apply for free or low-cost insurance if you qualify. Just contact our Financial Counselor at (315) 255-7210 or go to our Patient Financial Services (PFS) Department between the hours of 7:00 AM and 3:00 PM for free, confidential assistance.
Who qualifies for a discount?
Financial Assistance is available for patients with limited incomes and/or no health insurance. Everyone in New York State who is needs emergency services can receive care and get a discount if they meet the income limits. Everyone who lives in New York State can get a discount on non-emergency, medically necessary services at Auburn Community Hospital if they meet the income limits. You cannot be denied medically necessary care because you need financial assistance. You may apply for a discount regardless of your immigration status.
What are the income limits?
The amount of discount varies based on your income and the size of your family. If you have no health insurance, these are the income limits:
| Family Size | Annual Family Income | Monthly Family Income |
|---|---|---|
| 1 | $60,240.00 | $5,020.00 |
| 2 | $81,760.00 | $6,814.00 |
| 3 | $103,280.00 | $8,607.00 |
| 4 | $124,800.00 | $10,400.00 |
| 5 | $146,320.00 | $12,194.00 |
| 6 | $167,840.00 | $13,987.00 |
What if I do not meet the income limits?
If you cannot pay your bill, Auburn Community Hospital offers a payment plan to those patients that do not meet the income limits. The amount you pay depends on the amount of your income.
Can someone explain the discount? Can someone help me apply?
Yes, free, confidential help is available. Call our Credit and Collections Department at (315) 255-7210 between the hours of 7:00 a.m. and 3:00 p.m.
If you do not speak English, someone will help you in your own language.
The Financial Counselor can tell you if you qualify for free or low-cost insurance, such as Medicaid, Child Health Plus and Family Health Plus.
If the Financial Counselor finds that you don’t qualify for low-cost insurance, they will help you apply for a discount.
The Counselor will help you fill out all of the forms and tell you what documents you need to bring.
What do I need to apply for a discount?
Please supply a form of picture ID, and last two pay stubs or proof of unemployment or other income.
If you cannot provide any of these, you may still be able to apply for financial assistance.
What services are covered?
All medically necessary services provided by Auburn Community Hospital are covered by the discount. This includes outpatient services, emergency care and inpatient admissions.
Charges from private doctors who provide services in the hospital may not be covered. You should talk to the private doctors to see if they offer a discount or payment plan.
How much do I have to pay?
The amount you pay for the services is dependent upon your income. Patients that qualify at or below 100 % of the federal poverty level will not be charged.
Our financial Counselor will give you the details about your specific discount(s) once your application is processed.
How do I get a discount?
You have to fill out the application form. As soon as we have proof of your income, we can process your application for a discount according to your income level.
You can apply for a discount before you have an appointment, when you come to the hospital to get care or when the bill comes in the mail.
Send the completed form to PFS Dept., Auburn Community Hospital, 17 Lansing Street, Auburn, New York 13021 or bring it to our PFS Department. You have up to 240 days after the date of the first post-discharge bill to submit the application.
How will I know if I was approved for the discount?
Auburn Community Hospital will send you a letter within 30 days after completion and submission of the documentation, telling you if you have been approved and the level of the discount you received. If denied financial assistance, the patient or patient’s guarantor, may re-apply at any time there has been a material change of income or status or six months after the date of denial or appeal decision.
Appeal Process for Patients
If a patient wishes to appeal a determination with regard to Charity Care or Financial Assistance, their written request and reason for an appeal should be directed to the address listed below, with all pertinent forms and documentation. The Director of Revenue Cycle or his/her designee will review the case and supporting documentation, discuss any and all pertinent issues with the patient, or the responsible party. A final decision with regard to the appeal will be issued in writing within 30 days of receipt of the written appeal.
PFS Dept.
Attn: Appeals
Auburn Community Hospital
17 Lansing Street
Auburn, NY 13021
What if I receive a bill while I’m waiting to hear if I can get a discount?
You cannot be required to pay a hospital bill while your application for a discount is being considered. If your application is turned down, the hospital must tell you why in writing and must provide you with a way to appeal this decision to a higher level within the hospital.
What if I have a problem I cannot resolve with the hospital?
You may call the New York State Department of Health complaint hotline at 1-800-804-5447.
Financial Assistance Application.
