Eligibility Criteria for Charity Care and/or Financial Assistance
California requires all hospitals to provide financial assistance to people and families who meet certain income requirements. You or your family member may qualify for free care or reduced-price care based on your family size and income, even if you have health insurance.
Charity Care is generally secondary to all other financial resources available to the patient, including the following:
- Group or individual Medical Plans
- Workers’ Compensation
- Medicare
- Medi-Cal or Medical Assistance programs
- Other State, Federal, or Military Programs
- Any Other Third Party (e.g. auto accidents or personal injuries) or any other situation where another person or entity may have a legal responsibility to pay for the costs of medical services.
In those situations where appropriate primary payment sources are not available, for medically necessary hospital care received on or after Jan 1, 2022, Vibra Hospital of Sacramento will consider patients for Financial Assistance and Charity Care under this policy, when Third-Party Coverage, if any, has been exhausted, based on the following criteria:
| Income as a Percentage of Federal Poverty Level | Percentage Discount | Category |
|---|---|---|
| Less than or equal to 200 percent | 100 percent | Full Charity Care |
| 201-300 percent | 75 percent | Financial Assistance |
| 301-400 percent | 50 percent | Financial Assistance |
- The full amount of patient or guarantor responsibility for hospital charges will be determined to be Charity Care for the patient or their guarantor whose income is at or below 200% of the current federal poverty level, adjusted for family size. Vibra Hospital of Sacramento will not consider the value of assets to reduce Charity Care discounts for individuals in this category.
- Seventy-five percent of patient or guarantor responsibility for hospital charges will be determined to be Charity Care/Financial Assistance for a patient or their guarantor whose income is between 201% and 300% of the current federal poverty level, adjusted for family size. Discount may be reduced by amounts reasonably related to assets as set forth in application.
- Fifty percent of uncovered hospital charges will be determined to be Charity Care/Financial Assistance for a patient or their guarantor whose income is between 301% and 400% of the current federal poverty level, adjusted for family size. Discount may be reduced by amounts reasonably related to assets as set forth in application.
- Catastrophic Charity: Vibra Hospital of Sacramento may write off Charity Care amounts for patients with family income more than 400% of the federal poverty level when circumstances indicate severe financial hardship or personal loss.
- Vibra Hospital of Sacramento will not require a disclosure of assets from Charity Care applicants whose income is less than 200% of the current Federal Poverty level but may require a disclosure of resources from Charity Care applicants whose income is at or above 201 percent of the current federal poverty level.
- The patient’s or the patient’s guarantor’s financial obligation which remains after the application of any Charity Care or Financial Assistance schedule shall be payable as negotiated between Vibra Hospital of Sacramento and the responsible party. The responsible party’s account shall not be turned over to a collection agency unless payments are missed or there is some period of inactivity on the account, and there is no satisfactory contact with the patient.
Hospital Bill Complaint Program
The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program. Go to HospitalBillComplaintProgram.hcai.ca.gov for more information and to file a complaint.
How to Apply for Charity Care or Financial Assistance
Any patient at Vibra Hospital of Sacramento may apply to receive financial assistance. A patient seeking Charity Care or Financial Assistance must provide supporting documentation specified in the application unless Vibra Hospital of Sacramento indicates otherwise. The application form is available here, in the admission packet provided at the beginning of your stay, or on request at Vibra Hospital of Sacramento.
For your application to be processed, you must:
- Provide information about your family, including the number of family members in your household (family includes people related by birth, marriage, or adoption who live together).
- Provide information about your family’s gross monthly income (income before taxes and deductions).
- Provide documentation for family income and declare assets.
- Attach additional information if needed.
- Sign and date the form.
- You do not have to provide a Social Security number to apply for financial assistance; the number is used to verify information provided to us. If you do not have a Social Security number, please mark “Not Applicable” or “NA”.
- Mail or fax completed application with all documentation to Vibra Hospital of Sacramento, attention Administration.
To submit the completed application in person, please submit it to the Patient Relations Representative, at Vibra Hospital of Sacramento.
We will notify you of the final determination of eligibility and appeal rights, if applicable, within 14 calendar days of receiving a complete financial assistance application, including documentation of income. We want to help. Please submit your application promptly! You may receive bills until we receive your completed application.
