|
Charity Care
Charity Care Policy
La Póliza de Cuidado Caritativo
Application Instructions
Instrucciones de Solicitar
Charity Care Application
Aplicacìon para Cuidado Caritativo
|
Application Instructions
Enclosed you will find an application for Charity Care consideration. You have 110 days from the date of your hospital service or discharge to submit a completed charity care application with all required documents attached (see below). This form must be completed and signed by the patient or his/her guarantor and returned to Winthrop University Hospital at the following address:
Winthrop-University Hospital
700 Hicksville Road, Suite 203
Bethpage, NY 11714
Att: Charity Care Determination
In addition to this form you MUST include photocopies of the following documents:
- Your income tax return for the year(s) ________
- If employed, your IRS Forms W-2 and/or 1099 for the past 2 years
- Pay stubs, Social Security checks, Unemployment or Compensation papers for the past 3
- Other ________________
You will continue to be billed by the Hospital until all documentation has been received and a final determination has been made. You are not required to make any payments to the hospital until a final decision regarding your eligibility has been made, usually within two or three weeks after submission of your completed application and required documentation.
If you have already submitted some proof that may qualify you for assistance you may see a reduction to your bill while we await your submission of the completed Charity Care application and other required documents. This reduction represents the minimum amount of relief you will receive if all documents are received and your application is approved. Additional reductions to your bill may be available once your application is reviewed.
Please note that if you do not submit the application and all required documents within the required time frame, or we determine that you are not eligible for Charity Care under our guidelines, you will be re-billed and will be responsible to pay full charges for the services provided to you.
If you have any question regarding our Charity Care policy or the completion of the Charity Care Application please call (516) 576-5600, option #3 and ask for assistance.
|
