Healdsburg Hospital
Nonprofit critical access hospital in Healdsburg, CA.
Verified from the hospital's own policy
Healdsburg Hospital likely gives free care to households with a yearly income up to $47,880 for 1 person, $64,920 for 2, $81,960 for 3, $99,000 for 4, $116,040 for 5 or $133,080 for 6. It likely gives a discount to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6.
The hospital makes the final decision.
| People in household | Free care up to | Discount up to |
|---|---|---|
| 1 | $47,880 | $63,840 |
| 2 | $64,920 | $86,560 |
| 3 | $81,960 | $109,280 |
| 4 | $99,000 | $132,000 |
| 5 | $116,040 | $154,720 |
| 6 | $133,080 | $177,440 |
Discount steps
- 0% to 300% of poverty level, you pay $0 (100% write-off of patient responsibility)
- 301% to 400% of poverty level, you pay 88% discount off original charges
- 0% to 400% of poverty level, you pay $0 if medical expenses at Providence hospitals in the prior 12 months were over 20% of family income
How to apply
- Call (855) 229-6466 and ask for financial assistance.
- Application form
- Providence Financial Assistance (Charity Care) Policy, California (PSJH RCM 002 CA, dated 2/16/2023, implementation 4/1/2023, marked Draft)
- Bring proof of gross monthly income such as pay stubs, W-2 forms, tax returns, or Social Security award letters, statements for income drawn from assets, and documentation of assets.
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.
- Savings and property
- The policy counts savings or property, not only income.
- Very large bills
- Free care up to 400% of the poverty level if medical expenses at Providence hospitals in the prior 12 months were over 20% of family income. Other catastrophic expenses are handled case by case.
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 services at covered hospitals, including their inpatient and outpatient departments and clinics.
- Not covered
- Experimental or investigative care is excluded. Services provided by other organizations may not be covered. Each hospital keeps a list of covered and non-covered doctors at providence.org/obp.
State program in California
Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)
Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.
Income levels in the program are discount up to 400% of poverty level.
Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.
Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).
Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty
Program source, checked 2026-11-10
Hospital Bill Complaint Program (HCAI)
A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.
Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.
File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.
If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.
Program source, checked 2026-11-10
Emergency physician discount rule
Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.
Income levels in the program are discount up to 400% of poverty level.
Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.
Ask the emergency physician group named on the bill for its discount payment policy.
an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care
Program source, checked 2026-11-10
Notes
This is the only policy Healdsburg Hospital has filed with the state, and it is from 2023. It conflicts with itself. The scope section says the policy covers every Providence hospital in California except Healdsburg Hospital. The covered facility list then names Healdsburg Hospital as a NorCal HealthConnect hospital. Call the hospital to confirm which policy applies. Under the Northern California table, care is free at or below 300% of the poverty level. From 301% to 400% you get 88% off charges. If your medical bills at Providence hospitals in the past 12 months were over 20% of your income, care is free up to 400%. No one who qualifies pays more than the amount generally billed. The policy counts some assets, though not the first $100,000 of savings, your home, or retirement accounts. California law has not allowed hospitals to count savings since 2025, so ask about this if it comes up. You get an answer within 30 days of a complete application. Appeals go to the Providence Regional Business Office, P.O. Box 3268, Portland, OR 97208-3395, within 30 days. The policy gives no deadline to apply. The phone number is Providence's system-wide customer service line. The other number printed is (503) 215-7575. The state lookup page also lists the name Healdsburg District Hospital.
Sources
- Free care level
family size, is at or below 300% responsibility amounts. of the current FPL guidelines
- Discount level
The patient is eligible for a discount of 88% from original
- Discount steps
Income Qualifications for Providence Hospitals in Northern California and NorCal Health Connect Hospitals in Northern California
- Insured patients
coinsurance, deductible, and copayment amounts related to insured patients.
- Asset test
Income, certain assets, and expenses of the patient will be used in assessing the patient's individual financial situation.
- Very large bills
Providence, at its' discretion, may grant charity in the event of a catastrophic medical expense.
- What is not covered
Financial assistance may not cover all health care costs, including services provided by other organizations.
- Documents
statements for income drawn from assets, and declare and provide documentation for assets.
- Financial counseling phone
Customer Service Representatives at: 503-215-7575 or 855-229-6466 Monday-Friday 8:00 am to 5:00 pm
- Facility list
NorCal Health Connect Hospitals Petaluma Valley Hospital Healdsburg Hospital
- Scope conflict
This policy applies to all Providence hospitals in the state of California (with the exception of Healdsburg Hospital)
Last checked. 2026-11-10
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