Financial Assistance Program

Crouse Hospital understands that patients may be faced with a difficult financial situation when they receive medical bills for their hospital care. To meet the needs of our patients, we offer a Financial Assistance Program that includes a process to provide patients with assistance in applying for publicly sponsored New York State health insurance programs and offering charity care discounts. The hospital offers charity care discounts to patients who receive medically necessary care at no charge or reduced charge when they meet eligibility requirements.

If you have questions about Crouse Hospital’s Financial Assistance Program please call 315-470-7030.

Crouse Hospital Official Financial Assistance Policy
Financial Assistance Summary
Financial Assistance Application
Charity Care Discount Guidelines
Self Attestation of Income Form

+When can I apply for assistance?

Patients are encouraged to submit their application for a charity care discount prior to receiving services at Crouse Hospital or within 240 days from the completion of the hospital service. However, Crouse Hospital will allow patients to apply for a charity care discount even after their account has gone into a collection status. You may download the application and self attestation income form here or contact our Financial Counseling Department at 315-470-7030 to have an application mailed out to you

+How is eligibility determined?

Applicants for charity care may be screened for Medicaid eligibility by a Crouse Hospital Financial Counselor. Charity Care applications must be completed with proof of income or self attestation if no documented proof of income is available. Eligibility for a discount is based upon households with incomes up to 340% of the Federal Poverty Level.

2016 Charity Care Discount Guidelines

Household Size Maximum Household Income for Discount
1 $40,018
2 $54,162
3 $68,306
4 $82,450
5 $96,594
6 $110,738
7 $124,882
8 $139,026
Each Extra Person Add $14,144

+What providers and services are covered under this program?

Consideration for charity care will apply to eligible services that are considered essential health services provided, either as an inpatient or outpatient, and billed under Crouse Hospital. Charity care does not cover convenience items (such as telephone and television service) or cosmetic services. Charity care discounts are also available to patients to decrease the cost of coinsurance, co-payments and deductibles.

+Are there limits to eligibility based on residency?

Charity care discounts are available to patients who are residents of New York State only. For uninsured patients residing outside of New York State and who receive services at Crouse Hospital a self-pay discount of 30 percent off charges is available.

+What happens after I apply?

A determination will be based on information provided. You will be notified in writing of the determination.

  • 100% approval or a small nominal fee
  • Partial approval: Those who have been accepted and who have income between 101 percent and 340 percent of the federal poverty guidelines will receive a partial sliding scale discount based on an amount generally billed reimbursement rate.
  • Denial: Denials are based on information provided by the patient and will be specific as to what Charity Care eligibility the patient did not meet.

+If I am responsible for a balance, may I make payment arrangements?

Certainly – Crouse Hospital accepts payment arrangements. A hospital representative will assist you in the payment arrangements to be set up based on your income and the balance of the bills.

+If I have health insurance may I still qualify for any type of discount?

Yes. If approval is made any discount awarded will be applied to coinsurances, co-payments and deductibles.

+Are translator services available?

Yes, translator services are available to assist with the application process. To request translator assistance please call 315-470-7030.

+How can I contact someone with general questions or help with completing my application?

For help with the charity care application process please contact a representative at 315-470-7030. We are here to assist you any way we can.

+How do I apply for charity care?

To apply for charity care, please fill out an application and send to:
Crouse Hospital
Attn: Financial Counseling
736 Irving Avenue
Syracuse, NY 13210

Download Financial Assistance Application (PDF)
Download Self Attestation of Income Form (PDF)