Financial Assistance Plain Language Summary

Orleans Community Health’s Financial Assistance Policy exists to provide eligible patients, partial or fully discounted healthcare services to uninsured, underinsured, or patients with an inability to pay for medically necessary services.

Eligible Services – Emergency and/or medically necessary services provided by Orleans Community Health

Eligible Patients – Patients who do not qualify for Medicaid, Child Health Plus, Family Health Plus.

What is not Covered – The Financial Assistance Program will NOT cover services provided by physicians not employed by the hospital.

  • You can find a list of the plans in which we participate here.
  • You can find a list of our contracted physicians here.

How to Apply:  Information on financial assistance and applications may be obtained online at  Click HERE  for the application or you can pick up a paper copy at the hospital front desk or Business Office.  You may also call (585)798-8053 and request a copy be mailed to you.  Mail completed applications (with all documentation/information specified in the application instructions) to the address listed on the application.  You can also drop your application at the hospital Front Desk or Business Office.

Determination of Financial Assistance Eligibility – In general, eligible patients may receive financial assistance, using a sliding scale, when their family income is at or below 400% of the Federal Poverty Guidelines (FPG).  Eligibility for financial assistance means that eligible patients will have their care covered fully or partially and they will not be billed more than the amounts generally billed (AGB) to insured persons (AGB, as defined in IRC section501® by the Internal Revenue Service).  Financial Assistance levels are based solely on family income.

All patients seeking healthcare services at Orleans Community Health are assured that they will be served regardless of their ability to pay. No one is refused service because of a lack of financial means to pay.

Financial Assistance / Charity Care Policy & Procedure

Financial Assistance / Charity Care FAQ’s

Financial Assistance / Charity Care Application

Financial Assistance / Charity Care Application Instructions

Federal Poverty Guidelines

Release of Information Form