# Holy Cross Hospital-Jordan Valley

Hospital in West Jordan, UT. Verified from the hospital's own policy.

Holy Cross Hospital-Jordan Valley 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. We have not found an income level where care is free.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | not found | $63,840 |
| 2 | not found | $86,560 |
| 3 | not found | $109,280 |
| 4 | not found | $132,000 |
| 5 | not found | $154,720 |
| 6 | not found | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 250% of poverty level, patient pays $650 copay per inpatient, observation or same-day surgery visit, $50 per outpatient visit, 15% of CommonSpirit doctor fees
- 251% to 299% of poverty level, patient pays 10% of hospital charges, 25% of CommonSpirit doctor fees
- 300% to 399% of poverty level, patient pays 20% of hospital charges, 35% of CommonSpirit doctor fees

## How to apply

- Call 801-561-8888 ext. 3295 and ask for financial assistance.
- [Application form](https://csdam.widen.net/s/z2tgdtk2jp/financial-assistance-required-documentation)
- [Financial Assistance Program, Patients (CommonSpirit Health Mountain Region)](https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy)
- [Plain language summary](https://csdam.widen.net/s/gdtvggffsh/chadm-011-process-of-applying-for-financial-assistance)
- The policy gives 240 days to apply. Ask the billing office which date the count starts from.
- Bring photo ID, proof of address (2 items, such as a utility bill, lease or rent receipt), proof of income for the last 90 days for everyone in the household (tax return, W-2, pay stubs, benefit letters), bank statements for the last 3 months, statements for savings, investments, trust funds and similar assets, copies of all insurance cards, or a letter saying you have no insurance, any crowdfunding or gift fund set up to pay medical bills, a notarized letter explaining how you get by, if you have no income.
- Residency. Must live in the hospital's market service area, unless the visit was urgent or an emergency
- Savings and property. The policy counts savings or property, not only income.
- Very large bills. What the patient owes under the policy will not be more than 25% of yearly income
- Languages. English, Spanish

## 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 and other medically necessary care at the hospital, and at the CommonSpirit doctors and practices listed in the policy.

Not covered. Care that is not medically necessary is not covered. Some doctors who work at the hospital bill on their own and are not covered (see Addendum C of the policy). Scheduled care for people who live outside the service area needs approval first. People who live outside the United States need approval first.

## Notes

In Utah the lowest income levels get the rest of the bill written off, but a copay stays. That copay is $650 for a hospital stay or same-day surgery, $50 for an outpatient visit, and 15% of CommonSpirit doctor fees. Because of the copay, this page does not list a fully free income level. The policy text names 150% of the poverty level for the write-off, while its table and the summary use 250%. Ask the hospital which applies. Uninsured patients who are homeless may have the whole bill forgiven. The hospital counts savings and investments along with income. The bill under this policy will not be more than 25% of yearly income. Apply within 240 days of the first bill after you leave the hospital. Payment plans have no interest. Help with applying is at 888-347-3295 or CSFinancialAssistance.MtRegion@CommonSpirit.org. The posted policy is dated March 2024.

## Sources

- Discount level https://csdam.widen.net/s/gdtvggffsh/chadm-011-process-of-applying-for-financial-assistance
  > annual family income between 0%-400% of the Federal Poverty Level, you may be eligible to have your balance for services reduced
- Discount steps https://csdam.widen.net/s/gdtvggffsh/chadm-011-process-of-applying-for-financial-assistance
  > 0% - 250% $650 copay per visit $50 copay per visit 15% of charges
- Copay at lowest level https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > 100% reduction from gross charges (i.e., full write-off) less the applicable copay.
- Homeless https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > Uninsured homeless patient accounts will be adjusted at 100% without a copay.
- Insured patients https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > Insurance programs leaving a patient balance may be eligible for CommonSpirit Health Mountain Region financial assistance if the patient meets financial screening requirements.
- Asset test https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > A patient’s Adjusted FPL will be calculated using the patient’s household income plus liquid assets and household family size.
- Residency https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > Established residency in CommonSpirit Health Mountain Region's market service area is required, unless the visit is due to an urgent or emergent visit.
- Very large bills https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > In addition to an income level evaluation as outlined above, the amount of patient responsibility will not exceed 25% of annual income.
- Deadline https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > CommonSpirit Health Mountain Region will accept a FAA Form up to 240 days from the date of the first post-discharge statement.
- Documents https://csdam.widen.net/s/z2tgdtk2jp/financial-assistance-required-documentation
  > Proof of residency (2 required). i.e., phone or utility bill, rent receipts/lease, trash.
- Languages https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > The FAP, FAA and PLS are available in English and Spanish.
- What is not covered https://csdam.widen.net/s/7k58d7g55q/financial-assistance-policy
  > Non-medically necessary services and procedures will not qualify for CommonSpirit Health Mountain Region's FAP.
- Covered facility https://csdam.widen.net/s/mvrvt6rhb2/addendum-a---covered-facilities
  > Holy Cross Hospitals Jordan Valley
- Financial counseling phone https://csdam.widen.net/s/7fwnfrxpsz/addendum-d---hospital-counselor-locations
  > Holy Cross Hospital – Jordan Valley 3580 W 9000 S ... Financial Counseling: 801-561-8888 ext. 3295

Last checked 2026-11-11.

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