Financial Assistance Program

If you are uninsured AND if you do not qualify for public health insurance, it is important that you let us know as soon as possible. We may be able to help.  
 
As a resident of the North Shore-LIJ service area (Long Island and NYC), you may be eligible to receive financial assistance for your hospital/medical bills through the North Shore-LIJ Financial Assistance Program.

 

Eligibility

To determine whether or not you may be eligible, consult the table below to see if your family falls below the maximum yearly income.

Family Size Maximum Yearly Income
1 $55,850
2 $75,650
3 $95,450
4 $115,250
5 $135,050
6 $154,850
7 $174,650
8 $194,450
9 $214,250
10 $234,050
11 $253,850
12 $273,650

 

Apply for Financial Assistance

To apply for financial assistance, please download, print, sign, and mail us a completed copy of the Financial Assistance Application. We offer the application in several languages:

(If you're unable to download or print, and would like us to mail you an application, please fill out and submit an online Financial Assistance Application form.)

Be sure to attach all requested documentation. If we do not receive all of your documentation, we cannot process your application.

All of the information in your application will be kept strictly confidential.

Filing Time Limits

You have 90 days from the date of treatment to apply for the Financial Assistance Program.

Restrictions

The following items are NOT covered under the Financial Assistance Program:

  • Prescriptions
  • Co-Pays
  • Co-Insurance
  • Deductibles
  • Personal items (e.g., telephone, private room differential, guest meals, etc.)

After You Apply

Once you have submitted a complete application with all requested documentation, you can disregard all bills for the services that you are requesting that we cover under our Financial Assistance Program until a final decision is made.

We will contact you within 30 days either by telephone or by mail to let you know the outcome of your application.

If Your Application Is Approved

If you are approved, we will let you know what your new account balance is.

If you need help with a payment plan for your new account balance, the Financial Assistance Unit can help you set up a monthly payment plan for the new balance.

If Your Application Is Not Approved

If your application for Financial Assistance is not approved you can appeal the decision by writing to us and submitting any additional information and/or documents that you would like us to review. If you do not wish to appeal the decision, please call our Financial Assistance Unit at (888) 214-4065 to set up an affordable monthly payment plan. You can also go to Make a Payment to set up a monthly payment plan and pay online.

For more information, call us at (888) 214-4065 or fill out our Contact Us form.

Last Update

June 8, 2012
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