# Covenant Hospital Levelland

Hospital in Levelland, TX. Verified from the hospital's own policy.

Covenant Hospital Levelland likely gives free care to households with a yearly income up to $31,920 for 1 person, $43,280 for 2, $54,640 for 3, $66,000 for 4, $77,360 for 5 or $88,720 for 6. We have not found a discount for incomes above the free care level.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $31,920 | not found |
| 2 | $43,280 | not found |
| 3 | $54,640 | not found |
| 4 | $66,000 | not found |
| 5 | $77,360 | not found |
| 6 | $88,720 | not found |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 200% of poverty level, patient pays nothing (100% write-off)

## How to apply

- Call 1-855-229-6466 and ask for financial assistance.
- [Application form](https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/application/covenant/cov-fa-app-eng.pdf)
- [SJH Texas Financial Assistance (Charity Care) Policy (PSJH RCM 002 TX)](https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf)
- [Plain language summary](https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring proof of income (W-2, recent pay stubs, last year's tax return, or a signed statement from an employer), a signed statement describing income if there is no proof, bank statements (only asked of Medicare patients who do not also have Medicaid).
- Savings and property. The policy counts savings or property, not only income.
- Very large bills. Patient bills over $75,000 count as a catastrophic medical event. Management may grant help based on the amount owed, income and assets, and the patient pays no more than AGB.

## If you have insurance

Insured patients can also apply for help with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## What is covered

Covered. Emergency, urgent and other medically necessary care at the hospital, including its inpatient and outpatient departments and clinics. Both uninsured and insured patients can apply, and help can go toward deductibles, coinsurance and copays.

Not covered. Cosmetic, experimental or research care and care for convenience are not covered. Doctors and groups that are not Covenant employees bill separately and may not accept Covenant financial assistance. Ask for the provider list.

## Notes

Help can cover what is left after insurance, like deductibles and copays. Apply within 240 days of the first bill after you leave the hospital, though the hospital may accept later applications. The written policy has no partial discount tier. Income above 200% of the poverty level gets no income-based discount, though uninsured patients get a discount and very large bills (over $75,000) may be reviewed. People on Medicaid, SNAP, CHIP, WIC or similar programs may be approved without a full application. Payment plans have no interest and are capped at 10% of monthly income after living costs. A denial can be appealed within 30 days.

## Sources

- Free care level https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > Annual family income, adjusted for family size, is at or below 200% of the current FPL guidelines,
- Discount level https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf
  > Generally, patients with a family income at or below 200% of the Federal Poverty Level will
- Asset test https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > A patient’s income, certain assets, and expenses will be used in assessing the patient’s individual financial situation.
- Very large bills https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > Patient incurs financial liability exceeding $75,000.00
- Insured patients https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > Financial assistance is available to both uninsured and insured patients if they meet the requirements of this policy.
- Deadline https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > The FAP-Eligible Time Period for (i) hospital services is the 240-day period of time;
- Documents https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/application/covenant/cov-fa-app-eng.pdf
  > REMEMBER: You must include proof of income with your application.
- Financial counseling phone https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf
  > Speak with a Financial Counselor at 1-855-229-6466, Monday–Friday, 7 a.m. to 5:30 p.m.
- What is not covered https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/pls/tx/plain-language-summary-texas-english.pdf
  > Services performed by non-Covenant employed providers will bill separately and may or may not accept Covenant approved Financial Assistance.
- Covered facility https://www.providence.org/-/media/project/psjh/shared/files/financial-assistance/policy/covenant/tx/fa-policy-english.pdf
  > Covenant Hospital Levelland

Last checked 2026-11-11.

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