Chinese Hospital is committed to helping patients who do not have the means to pay for emergency care and other medically necessary health care services through its financial assistance programs.
You can find details below about our financial assistance programs and how to apply.
Financial Assistance Programs
If you have questions about these programs, contact us at:
Patient Financial Services Department
Phone: 1-415-677-2314
Email: [email protected]
Office: 845 Jackson St, Lobby Floor, San Francisco, CA 94133
Hours: Monday to Friday, 8:30 a.m. – 4:30 p.m.
Financial Assistance: Patient financial assistance in our Shoppable Services Program offers an intuitive way to help you estimate your out-of-pocket cost of care for common exams, procedures, tests, and services. The Shoppable Service Program can be found at Price Transparency Page.
Chinese Hospital Discount Policy: Patients who do not have health insurance – or who need care that is not covered by an insurance plan – are considered self-pay patients and are eligible for a discount at Chinese Hospital. To find out more about our discount policy, call Patient Financial Services.
Facing Financial Hardship? We encourage you to apply to Medi-Cal and other government programs that may be of assistance. If you do not qualify for those programs, or you have substantial financial liabilities despite having insurance, you may qualify for our financial assistance program at Chinese Hospital.
Eligibility for Financial Assistance: Financial assistance is based on your family size and income, even if you have health insurance. Families with an income at or below 400 percent of federal poverty level (FPL) guidelines are generally eligible for financial assistance from Chinese Hospital. Check here for details:
| Family Size | 100% Financial Assistance (maximum income) |
| 1 | $62,600 |
| 2 | $84,600 |
| 3 | $106,600 |
| 4 | $128,600 |
| 5 | $150,600 |
| 6 | $172,600 |
| 7 | $194,600 |
| 8 | $216,600 |
| More than 8 | Add $22,000 for each additional person (400% of $5,500) |
HOW TO APPLY / RECEIVE A COPY
To apply for financial assistance, please download the application below and send it to: Chinese Hospital Patient Financial Services Department, 845 Jackson St, Lobby Floor, San Francisco, CA 94133.
To receive a free copy of the FAP and FAP application form by mail, please contact our Patient Financial Services Department. A representative will obtain your mailing address and mail the application form to you.
For assistance with applying for FAP, a representative from Patient Financial Services will help you with the form. A completed application can be mailed to Patient Financial Services, 845 Jackson St, San Francisco, CA 94133. For faster service, you may email to [email protected].
Note: Your completed application for financial assistance should be submitted after services are provided and is not a substitute for insurance or a guarantee of future services.
Financial Notices
- Financial Assistance Policy English Chinese/中文 Spanish/Español
- Financial Assistance Application Form English Chinese/中文 Spanish/Español
- Help Paying Your Bill Notice English Chinese/中文 Spanish/Español
- Help Paying Your Bill Notice – Wall Posting English Chinese/中文 Spanish/Español
- Discharge Notice English Chinese/中文 Spanish/Español
Audio Recordings of Financial Notices
We’ve provided audio recordings of our Help Paying Your Bill Notice for patients who require audio-based communications. If you need this information in a different format than the recordings or the PDF linked above, please call Patient Financial Services at 1-415-677-2314 or visit Patient Financial Services. The office is open Monday-Friday, 8:30am – 4:30pm, located at Chinese Hospital, 845 Jackson Street, Lobby Level, San Francisco, CA. Aids and services for people with disabilities, such as large print, audio and other accessible electronic formats are also available. These services are free.
- Help Paying Your Bill Notice – English
- Help Paying Your Bill Notice – Spanish/Español
- Help Paying Your Bill Notice – Cantonese/粵語
- Help Paying Your Bill Notice – Mandarin/國語
Eligible Services
Professional fees that are not billed by Chinese Hospital will not be covered under this Financial Assistance Policy, except as may be provided for under other policies or contracts. Professional fees not billed by Chinese Hospital include:
- SCP Health to California Emergency Associates
- Golden Gate Radiology
- San Francisco Unified Physicians Group
- Pacific Pathology Medical Associates
- Henry Hu, MD, Professional Corporation
Questions
Additional information and/or a statement of charges for services rendered by the hospital may be obtained by calling Patient Financial Services Department at 1-415-677-2314 or visiting us at our office located at 845 Jackson St, Lobby Floor, San Francisco, CA 94133, we are available Monday to Friday, 8:30 a.m. – 4:30 p.m.
Complaint
The California Department of Health Care Access and Information (HCAI) Hospital Bill Complaint Program investigates patient complaints and can assess administrative penalties against hospitals for violations of the Hospital Fair Pricing Act. If you believe you were wrongly denied financial assistance, you may file an online complaint to HCAI.
