Hospital Financial Assistance
If you are unable to pay for your hospital bills, you may apply for financial assistance offered through the Mount Sinai Health System Hospitals' Department of Financial Counseling. It is important that you contact us as soon as possible. We are here to help.
How to apply for Financial Assistance:
Mount Sinai St. Luke's
To apply for financial assistance at Mount Sinai St. Luke's, please download, print, sign, and mail us a completed copy of the Financial Assistance Application. We offer the application in several languages:
Mount Sinai Roosevelt
To apply for financial assistance at Mount Sinai Roosevelt, please download, print, sign, and mail us a completed copy of the Financial Assistance Application. We offer the application in several languages:
Once we receive your application, we will contact you to schedule an appointment with one of our Financial Counselors. You may also apply for financial assistance in person by visiting the Department of Financial Counseling (“DFC”) located in each of our hospitals.
Please see the Contact Us section of our website for details how to contact a Financial Counselor who can assist you with your application. Once you have submitted a completed application you can disregard any hospital bills until we have rendered a decision on your application. All the information in your application will be kept strictly confidential.
If you have an income at or below 400% of the federal poverty income level (which is stated in the “Maximum Yearly Income” column in the chart, below), you are eligible to apply for financial assistance.
|Income Eligibility Guidelines for Financial Assistance.|
|Family size||Maximum Yearly Income|
Medical Services Covered Under Hospital Financial Assistance Program:
If you live within the five boroughs of New York City, you may apply for financial assistance for medically necessary services for emergency and non-emergency services based on financial need. The Hospital Financial Assistance Program applies to medically necessary inpatient and outpatient services, emergency services, ambulatory surgery, outpatient clinics, and ancillary services such as CT Scans, X-Rays and Blood Tests, etc. All other patients will have the opportunity to apply for financial assistance for emergency services (including emergency transfers under EMTALA) based on financial need.
Financial Assistance Through the Hospital Excludes:
Please note the following important information:
You must present the original approval letter each time you return to the hospital or clinic for a new visit or treatment. The Financial Assistance discount provided to you for inpatient,outpatient and ambulatory surgery procedures will be valid for one calendar year.
When applying for financial assistance, regardless of approval or denial of your application, an interest free payment plan is available with an agreed upon down payment and remaining balance to be paid in equal monthly installments. In the event of hardship, an extended payment plan option will be considered on a case by case basis.
A 10% prompt pay discount on full payment of the discounted charges is available. Payment is due within 30 days of billing and subject to normal collection procedures.
If you qualify for our financial assistance program, the monthly payment will be limited to 10% of your monthly income.
You have the right to appeal decisions on eligibility for financial assistance within 30 days of notification of an eligibility determination from the DFC, based on the following criteria:
Incorrect information was provided
Changes in your financial status occurred
The Director of the DFC will decide appeals in cases where incomplete information is provided or where financial status changes occur. For a case involving extenuating circumstances, a final decision on an appeal will be made by the Vice President of Patient Financial Services. Appeals should be made in writing (or in person, by appointment) to the Director of the DFC at the following address:
Department of Patient Financial Counseling
1111 Amsterdam Avenue at 114th Street
New York, NY 10025
Tel. (212) 523-4674 / Fax. (212) 523-5620
The Department of Patient Financial Counseling will strive to make appeal decisions within 10 business days of receipt of an appeal (i.e. after receipt of letter or an in person appeal).
Changes in Financial Status
You are responsible for promptly reporting changes in financial status and contact information to the DFC if you are unable to comply with a signed payment agreement.
Defaults on Financial Agreements
If you or a responsible party defaults upon a payment agreement with Mount Sinai Health System Hospitals after reasonable notice of non-payment, that agreement will become void, any remaining discounted balance will become due and the account in question will be considered delinquent. Furthermore, Mount Sinai Health System Hospitals reserve the right to refer your accounts to a collection agency, when appropriate.