Financial Assistance
In order to better serve the community, Alhambra Hospital Medical Center will accept a wide variety of payment methods and will offer resources to assist the patients in resolving an outstanding balance. Financial Assistance represents all other healthcare services that are provided to patients who are financially unable to satisfy their debts resulting from a determination of the patient's inability to pay. Designation as Charity Care will only be considered after all payment sources that could be a source of payment for the patient's bill has been exhausted.Are You Eligible?
- Patients who are below 250 percent of the Federal Poverty Level (FPL) or between 251 - 400 percent of the FPL and are either uninsured or insured with high medical costs are eligible to apply for full or partial Charity Care.• Patients eligible for full charity care, between 0 – 250 percent of the FPL, pay a zero amount.
• Patients eligible for partial charity care, between 251 – 400 percent of the FPL, pay 20 percent of the total charges.
• Patients above 401 percent of the FPL pay 40 percent of the total charges.
View Federal Poverty Guidelines:
Poverty Guidelines | ASPE (hhs.gov)Alhambra Hospital Medical Center will not report adverse information to consumer credit reporting agencies or begin civil action against a patient during the first 180 days after initial billing.
This requirement only applies to uninsured patients and patients with high medical costs whose eligibility for full and/or partial charity care is in process of being determined.
Alhambra Hospital Medical Center will not use wage garnishments or liens on primary residences to collect unpaid bills from patient eligible for full or partial charity care.
For more information about the Financial Assistance Program of Alhambra Hospital Medical Center, patients can call our Business Office Team at (626) 457-7997.
How to Apply
Fill Out an Application
Download and print the Financial Assistance application (select your language). Forms are also available at our Registration Department and Cashier’s Office.
CHARITY APPLICATION – ENGLISH
CHARITY APPLICATION – ENGLISH / SPANISH
Submit Your Application
By Mail:
Alhambra Hospital Medical Center
Attn: Business Office Department
100 S. Raymond Ave.
Alhambra, CA 91801
In Person:
Alhambra Hospital Medical Center
Attn: Business Office Department
100 S. Raymond Ave.
Alhambra, CA 91801
Need help getting the application, filling it out or turning it in?
Contact the Business Office Department at (626) 457-7997.
For patients currently admitted at the hospital, contact the Quality Control Coordinator at (626) 458-4718.
Application Review
Upon receipt of the application, the application is reviewed by staff at the Business Office Department to determine if the application has been completed and the supporting documents are attached.
The patient will continue to receive statements but will not be sent to a collection agency during the review process.
If the application is incomplete, the patient is sent a letter requesting the missing information.
The patient is given 15 days to return the requested information.
If the requested information is not received within 15 days, the patient will be called before canceling the Charity application.
Once the application is complete, the application is forwarded to the Business Office Director for determination.
If the application is approved, the patient will be sent an approval letter.
If the application is denied, the patient will be sent a denial letter with explanation.
The Business Office Director will make every reasonable effort to make the Charity Care determination as soon as possible.
