Pomona Valley Hospital Medical Center
Nonprofit acute care hospital in Pomona, CA.
Verified from the hospital's own policy
Pomona Valley Hospital Medical Center likely gives free care 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 a discount for incomes above the free care level.
The hospital makes the final decision.
| People in household | Free care up to | Discount up to |
|---|---|---|
| 1 | $63,840 | not found |
| 2 | $86,560 | not found |
| 3 | $109,280 | not found |
| 4 | $132,000 | not found |
| 5 | $154,720 | not found |
| 6 | $177,440 | not found |
Discount steps
- 0% to 400% of poverty level, you pay $0 (full Charity Care) for uninsured patients, and for insured patients with high out-of-pocket costs
- 401% to % of poverty level, you pay Discount Payment: inpatient capped at the Medi-Cal APR DRG amount (obstetrics and pediatrics) or Medicare DRG amount (all other); outpatient capped at the greater of Medi-Cal or Medicare rates
How to apply
- Call (909) 865-9501 and ask for financial assistance.
- Application form
- Charity Care Financial Assistance Policy (HW#501, effective 01/01/2025, revised 05/11/2026) and Discount Payment Policy (HW502, effective 09/04/2025)
- Bring recent pay stubs or recent income tax returns (only one is required), completed and signed application.
- 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.
- Very large bills
- Out-of-pocket costs at the hospital over 10% of family income (current or prior 12 months)
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
- Inpatient, outpatient, and emergency care that a doctor deems medically necessary at Pomona Valley Hospital Medical Center.
- Not covered
- Emergency doctors and other hospital-based doctors bill separately and give their own discounts (list in Addendum A). Medi-Cal share of cost and subsidized Covered California cost sharing are not eligible. Purely elective comfort services are not covered.
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
Free care at or below 400% of the poverty level, for patients with no insurance and for insured patients with high out-of-pocket costs. Above 400% everyone can get a discount payment with no application, and the policy sets no income limit. The discount caps the bill near what Medicare or Medi-Cal would pay. You are not eligible for help with a Medi-Cal share of cost or subsidized Covered California cost sharing. The policy gives no deadline to apply. You may need to apply again every 180 days. Appeals go in writing to the Director of Patient Financial Services, then the Chief Financial Officer. The policy does not say whether savings count, but the application asks about home, car, and bank account values. The phone number is the Eligibility Services Department from the application. For language help, call Customer Service at (909) 865-9100. The charity and discount policies are separate documents.
Sources
- Free care level
will receive full free when the patient’s family income is at or less than 400% of the Federal Poverty Level
- Discount level
All patients can qualify for a discount payment, this includes uninsured patients or patients with high medical costs.
- Discount steps
For outpatient services the expected payment shall not exceed the established MediCal or Medicare rates, whichever is greater.
- Insured patients
Patient is insured AND Patient’s Family Income is at or less than 400% of the Federal Poverty Level designated for the patient’s family size
- Very large bills
Annual out-of-pocket medical expenses incurred by the patient at the hospital that exceed lessor of 10% of the patient’s current family income
- What is not covered
The discounts by physicians providing emergency services in the hospital are not included in the Hospital’s Charity Care Financial Assistance Policy.
- Documents
To determine eligibility you are required to provide only one of these to show your income: recent pay stubs or recent income tax returns
- Financial counseling phone
Services Department 909-865-9501.
Last checked. 2026-11-10
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