Surprise Valley Community Hospital
Critical access hospital in Cedarville, CA.
Verified from the hospital's own policy
Surprise Valley Community Hospital 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.
| People in household | Free care up to | Discount 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 |
How to apply
- Call (530) 279-6111 and ask for financial assistance.
- Application form
- Financial Assistance Program (Charity Care) (board approved 9/28/2022, revised 8/26/2022)
- Bring a signed financial evaluation form listing income and expenses.
- 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
- Patients above 400% of the poverty level may be considered when care was caused by a catastrophic medical condition or other special situation.
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
- Medically necessary care at Surprise Valley Community Hospital. The policy says the district and all contracted providers are 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
Help is available up to 400% of the poverty level. The free care limit is left blank here because the policy contradicts itself. One line says the whole bill is forgiven at or below 400%. The next lines say only 75% is forgiven from 301% to 350%, and 25% from 351% to 400%. Ask the hospital which rule applies. Homeless patients get the whole bill forgiven. The policy says it looks at assets and may run credit checks, even though California stopped hospitals from counting assets in 2025. The policy is from 2022 and is a scanned copy. The application on file is a 2009 packet that includes an older version of the policy. The phone number is the hospital's main line, listed as the business department.
Sources
- Discount level
If a patient's income is more than 400% of the FPL, the patient will not automatically qualify for any write-off
- Free care poverty level note
If the patient's income is 400% or less of the FPL, the entire hospital bill will be forgiven.
- Discount tiers note
If the patient's income is between 301% and 350% of the FPL, 75% of the hospital bill will be forgiven.
- Insured patients
insured patients that are unable to pay patient liabilities may have all or part of their hospital bills covered
- Asset test
Allows the hospital to determine if the patient has declared income and/or assets giving them the ability to pay
- Very large bills
financial assistance may be considered when the specific circumstance of care was created by a catastrophic medical condition or other special situation.
- Documents
Information used by the financial assistance policy will be based upon a signed declaration of the patient or patient's family
- Financial counseling phone
For more information, please contact our business department at 530 279 6111.
Last checked. 2026-11-10
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