Financial Assistance / Charity Care

Charity Care Program

Dear Patient:

Orleans Community Health has designed a Charity Care Program to help New York State residents with their medical In order to complete this process, you must also have exhausted all other means of obtaining insurance coverage, including Medicaid and Child Health Plus. Please call, 585-798-8094 to make an appointment with our Financial Counselor to apply for Medicaid, Child Health Plus or the Marketplace.

Depending on your income level, your cost for services could be free or you could be charged a reduced rate.

If approved for either program, the coverage is valid for six months from the date on your application. Specific services that are not included under these programs are those services not provided by Orleans Community Health, such as Emergency Room physicians, Radiology reading physician, Surgeon, Anesthesiologist and Cardiologist fees.

In order to complete this process, you must also have exhausted all other means of obtaining insurance coverage, including Medicaid and Child Health Plus.

If deceased – documentation via the probate court must have “No Estate”

Bankruptcy – must be documented by “Discharge of Debtor” notice from the courts

Indigent – patient must follow the Charity Care Process and must have appropriate documentation of indigence.

All other patients must provide denials for Medicaid and Child Health Plus (for your children, if applicable), along with your completed application.  Your Medicaid denial must be for income reasons only, not for procedural reasons.

You must submit proof of all income for the last 12 months by providing one or more of the following: income tax return, 4 consecutive paystubs, unemployment documentation, social security or pension check or any other household proof of income.

Our policy states, once you are approved we can only go back 90 days for services prior to the date application.

 The Charity Care program is NOT an insurance coverage. If approved by Orleans Community Health, it is only valid for services provided by Orleans Community Health.  You must apply at other facilities in order to be covered elsewhere.

If you would like to apply for the Orleans Community Health Charity Care program, please fill out the attached application and mail it to the address at the bottom of the application with the supporting documents or you can drop them off at any Orleans Community Health location.

If you have any questions regarding what information is required, please call (585)798-8094 or (585)798-8622. We thank you for choosing Orleans Community Health for your healthcare needs.  We are confident you will be happy with the services you will receive at our facility.

Sincerely,
Mark Cye
Chief Financial Officer

Charity Care Program Overview
Financial Assistance Application
Financial Assistance FAQs
Release of Information Form