SIERRA NEVADA MEMORIAL HOSPITAL
155 GLASSON WAY
GRASS VALLEY, CA 95945
http://www.dignityhealth.com/sacramento/hospitals/
Contact:
Financial Counseling
(530) 274-6227
License:
General Acute Care Hospital
Total Beds: 104
Emergency Room: Yes
OSHPD ID:
106291023
Fair Pricing Policy Information
Policy Effective Date:1/1/2019
Download:
Federal Poverty Level for Free Care:
250%
Discount Payment Effective Date:1/1/2017
Discount Payments:
Discount Payment 1
FPL Range: 251%-350%
Payment Basis:
Medicare
Discount Payment 2
FPL Range: 351%-500%
Payment Basis:
Medicare
Other: Amount Generally Billed
Discount Payment 3
FPL Range: 0%-0%
Payment Basis:
Other Discount Payment Information:
Patients whose income exceeds 500% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Dignity Health facility.
Application Form Information
Application Form Eff Date:1/1/2016
Download:
Income Type Used:
Salary Received
Interest Received
Other: Business or Rental Income
Language Information
Available Languages:
English
Spanish
Vietnamese
Hmong
Tagalog
Cambodian
Korean
Chinese
Armenian
Russian
Other: Japanese
Additional Information
The attached word document contains the Financial Assistance Policy. This policy outlines the discounts for both 100% Charity Care and other payment discounts.
Source” : https://syfphr.oshpd.ca.gov/SearchDetail.aspx?oshpdid=106291023