VALLEY MEMORIAL HOSPITAL
1111 E. STANLEY BOULEVARD
LIVERMORE, CA 94550
https://stanfordhealthcare.com/
Contact:
Kristine Grajo, Director, PFS Self Pay
(650) 724-5286
License:
General Acute Care Hospital
Total Beds: 75
Emergency Room: Yes
OSHPD ID:
106010983
Fair Pricing Policy Information
Policy Effective Date:8/1/2016
Download:
Federal Poverty Level for Free Care:
400%
Discount Payment Effective Date:8/1/2016
Discount Payments:
Discount Payment 1
FPL Range: 400%-400%
Payment Basis:
Medicare
Medi-Cal
Other Government Insurance
Discount Payment 2
FPL Range: 0%-0%
Payment Basis:
Discount Payment 3
FPL Range: 0%-0%
Payment Basis:
Other Discount Payment Information:
Scenarios in which FPL is not a criteria for determining the patient’s charity care discount is for Special Circumstance Financial Assistance cases: Financial assistance that provides a discount to eligible patients with annualized family income in excess of 400% of the Federal Poverty Guidelines and financial obligations resulting from medical services provided by any SHC entity or provider that exceed 10% of annualized family income. Details are included within the policy.
Application Form Information
Application Form Eff Date:4/20/2020
Download:
Income Type Used:
Salary Received
Interest Received
Pension Received
Other: Income Tax Returns
Language Information
Available Languages:
English
Spanish
Vietnamese
Tagalog
Chinese
Russian
Additional Information
Charity Care FPL criteria has changed to 400% Application updated as Stanford-ValleyCare Revenue Cycle absorbed by Stanford Health Care. Financial Assistance Application is now standard for Stanford-ValleyCare and Stanford.
Source” :https://syfphr.oshpd.ca.gov/SearchDetail.aspx?oshpdid=106010983