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 607-798-5279.
