Financial Assistance Program Summary

 

It is the policy of Kingsbrook Jewish Medical Center to provide comprehensive quality health care and medically essential services without regard to a patient’s ability to pay or their immigration status. 

Kingsbrook Jewish Medical Center recognizes that there are times when patients in need of medical care may have difficulty paying for the services provided.  Kingsbrook Jewish Medical Center’s Financial Assistance Program provides discounts to qualifying individuals based on your income.  In addition, we can help you apply for free or low-cost insurance if you qualify.  Please contact our Financial Counselor’s at (718) 604-5499 or go to the Admissions Department (Patient Access Services Department), located in the Katz Building, First Floor, for free and confidential assistance.

 

Who qualifies for a discount?

Kingsbrook Jewish Medical Center has implemented a Financial Assistance Program which evaluates those who are underinsured, have exhausted their insurance benefits or are fully uninsured.  Current clinic patients without adequate financial resources can receive care in our primary / specialty clinics for fee schedules based on their income and family size.  A determination will be made if the patient is eligible for reduced fees. Non-Clinic patients seen in the Emergency Department, Inpatient, or for Outpatient Services can apply for assistance, based on financial need, through the Financial Assistance process in Patient Accounts, Patient Access Services/Financial Counseling or Ambulatory Care.

Everyone in New York State who needs emergency services can receive care and get a discount if they meet the income limits.  Any individuals residing in Kingsbrook Jewish Medical Center‘s primary service area,  which is defined as: East Flatbush, Flatbush, Canarsie, Flatlands, Bedford-Stuyvesant, Crown Heights and/or East New York (zip codes 11203, 11236, 11213, 11226, 11212, 11208, 11207, 11225, 11216), can get a discount on non-emergency, medically necessary services at Kingsbrook Jewish Medical Center, if they meet the income limits.  Kingsbrook Jewish Medical Center will never deny medically necessary care because you may need financial assistance.

You may apply for a discount regardless of your immigration status.

 

What are the income limits?

The amount of the discount varies based on your income and the size of your family.  Kingsbrook Jewish Medical Center’s Financial Assistance Program is based upon up to 300% of the January 2007 Department of Health and Human Services Federal Poverty Guidelines, as listed below.

 

KINGSBROOK JEWISH MEDICAL CENTER
FINANCIAL ASSISTANCE / SLIDING SCALE QUALIFICATION GUIDELINES
Revised for January 2007
Family	100 % Federal		200%	225%	250%	275%	300%
Size	Level		A	B	C	D	E
1	10,210		20,420	22,973	25,525	28,078	30,630
2	13,690		27,380	30,803	34,225	37,648	41,070
3	17,170		34,340	38,633	42,925	47,218	51,510
4	20,650		41,300	46,463	51,625	56,788	61,950
5	24,130		48,260	54,293	60,325	66,358	72,390
6	27,610		55,220	62,123	69,025	75,928	82,830
7	31,090		62,180	69,953	77,725	85,498	93,270
8	34,570		69,140	77,783	86,425	95,068	103,710
For each additional person, add $3,480.00.
POVERTY LEVEL				PATIENT RESPONSIBILITY
A	LESS THAN		200%	0% OF CHARGES
B	200%	TO	225%	20% OF CHARGES
C	225%	TO	250%	40% OF CHARGES
D	250%	TO	275%	60% OF CHARGES
E	275%	TO	300%	80% OF CHARGES
	OVER		300%	100% OF CHARGES
CLINIC	HOSPITAL		SLIDING SCALE
VISIT	CHARGE		FEE
			A	B	C	D	E
LEVEL 1	90.00		0	18.00	36.00	54.00	72.00
LEVEL 2	97.00		0	19.40	38.80	58.20	77.60
LEVEL 3	104.00		0	20.80	41.60	62.40	83.20
LEVEL 4	114.00		0	22.80	45.60	68.40	91.20
LEVEL 5	297.00		0	59.40	118.80	178.20	237.60
Kingsbrook Jewish Medical Center's Financial Assistance Program is based upon up to 300% of the January 2007 Department of Health & Human Services Federal Poverty Guidelines.

 

 

What if I do not meet the income limits?

If you cannot pay your bill, Kingsbrook Jewish Medical Center offers an extended, interest-free, payment plan to those patients that meet the income limits.  The amount of your payment installment depends on amount of your income and ability to pay.

 

Can someone explain the discount?  Can someone help me apply?

Yes, free, confidential help is available.  Please contact our Financial Counselor’s at (718) 604-5499 or go to the Admissions Department (Patient Access Services Department, Located in the Katz Building, First Floor for free, confidential assistance.  If you do not speak English, someone will help you in your own language. 

The Financial Counselor can tell you if you qualify for free or low-cost insurance, such as Medicaid, Child Health Plus and Family Health Plus.

If the Financial Counselor finds that you don’t qualify for low-cost insurance or Medicaid, they will assist you in accessing the Medical Center’s Financial Assistance program for any applicable discounts, including helping you with the appropriate forms and documentation requirements.

 

What do I need to apply for a discount?

Patients are requested to provide the following documentation, as available or applicable, in order to be evaluated for Financial Assistance:

o         Picture Identification

o         Proof of Address (letter/bill mailed to the patient at their address)

o         Income Tax 1040 (to verify dependents)

o         Proof of income

§          Four (4) most recent pay stubs (and/or)

§          a letter from the patient’s employer (and/or)

§          a statement from the patient stating income (and/or) 

§          if the patient does not work, a letter from the person supporting them

 

If you can not provide any of these, you may still be able to apply for financial assistance.

 

What services are covered?

All medically necessary services provided by Kingsbrook Jewish Medical Center are covered by the Financial Assistance Program.  This includes outpatient services, emergency care and inpatient admissions.

 

Charges from private doctors who provide services in the hospital may not be covered by this program.  You should talk to private doctors to see if they offer a discount or payment plan.

 

How much do I have to pay?

The amount for outpatient service or the emergency room starts from $18.00 to $237.60, depending on your Financial Assistance qualification category.

Our Financial Counselor will give you the details about your specific discount(s) once your application is processed. 

 

How do I get the discount?

You have to fill out an application form.  As soon as we have proof of your income, we can process your application for a discount according to your income level. 

You can apply for a discount before you have an appointment, when you come to the hospital to get care, or when the bill comes in the mail.

Send the completed form and supporting documentation to our Financial Counselor’s in the Patient Access Services (Admissions) Department or bring it to the Patient Access Services (Admissions) Department, located in the Katz Building, First Floor.

 

How will I know if I was approved for the discount?

Kingsbrook Jewish Medical Center will send you a letter, within 30 business days, after receipt of your completed application and supporting documentation, telling you if you have been approved for Financial Assistance and the level of discount you are eligible for. 

 

What if I receive a bill while I’m waiting to hear if I can get a discount?

You cannot be required to pay a hospital bill while your application for a discount is being considered.  If your application is turned down, Kingsbrook Jewish Medical Center will tell you why and provide you with a way to appeal this decision to a higher level within the hospital.

 

What if I have a problem I cannot resolve with the hospital?

You may call the New York State Department of Health complaint hotline at 1-800-804-5447.