Lourdes was established by the Daughters of Charity in 1925
to serve the people of this area, especially those in need. Today, we continue
our strong commitment to provide services to patients regardless of their
ability to pay.
Patients and/or Guarantors are responsible for payment of bills for
services provided by Lourdes. Lourdes has established the Patient Financial Assistance Program
to help patients who meet the income and
resources guidelines established by Lourdes, and who are not eligible for any other available program, such as Medicaid, Child Health Plus,
Family Health Plus, etc. It can also be used to assist with any copays or
deductibles of other programs. If we believe that you are eligible for
any other program, you must apply to that program and receive in writing,
an approval or denial before we can determine if you are eligible for the Lourdes
Patient Financial Assistance Program. This requirement enables us to serve
as many people as possible with our limited funds. This program is
available to the extent Lourdes’ resources allow.
A financial scale based on federal poverty income guidelines determines your
eligibility for the Patient Financial Assistance Program. How much your
Lourdes bill will be discounted depends on how your gross income and
resources compare with this financial scale.
If you are found eligible, your discount will apply to all charges
generated by Lourdes. Some services received at Lourdes are provided by
private physician groups, such as the services of a Radiologist or Anesthesiologist, and are
not covered because the bill you receive is not a Lourdes bill. A Lourdes Patient Financial Counselor
will be happy to answer any questions and to help you clarify your
charges.
To Apply for Lourdes Patient Financial Assistance Program:
- Download and Complete the application
(PDF).
- Please include the names and dates of birth of each adult who are
applying for assistance. If children under 21 are involved, we need the
names and dates of birth of the parents as well as all children under 21
in the family.
- Provide proof of total household income. Copies of pay stubs for the
most recent four week period, or a letter from your employer stating average monthly wages.
Include copies of
unemployment stub, Social Security benefits,
monthly pension or
any other sources of monthly income.
- We also need proof of any resources you may have. Resources include checking/savings
accounts, stocks, bonds and real estate property other than your primary residency. We do not include your home, tax deferred retirement or college
savings funds, or vehicles used by your immediate family.
- Mail the completed application and copies of required proofs to the
address at the bottom of the application. We will contact you once your application has been reviewed. If your application is denied, you may appeal this decision to the
Health Care Access Committee.
If you wish to speak with a financial counselor
contact the cashiers office at Lourdes Hospital at 607-798-5506 or
798-5279.