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Larkin at Exchange
Financial Assistance Program – Kaleida Health
726 Exchange Street
Buffalo, NY 14210

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Financial Assistance Program
Financial Assistance Summary

Kaleida Health recognizes that there are times when patients in need of care will have difficulty paying for the services provided. Kaleida Health’s Charity Care Program provides discounts to qualifying individuals based on your income and assets. In addition, we can help you apply for free or low-cost insurance if you qualify. Just contact our Charity Care/Facilitated Enroller Hotline at (716) 859-8979 for free, confidential assistance.

A free copy of the Financial Assistance Policy and FAP Application can be requested by mail at Larkin at Exchange, Suite 300, 726 Exchange Street. Buffalo, NY 14210. The applications are available in other languages

Who qualifies for a discount?

  • Financial Assistance is available for low income, uninsured individuals and those with insurance who meet the income/asset guidelines.
  • You cannot be denied medically necessary care because you need financial assistance.
  • You may be eligible for our charity care program regardless of immigration status

The amount of the discount varies based on your income and the size of your family. Income limits are based on 2020 federal poverty guidelines.

An FAP eligible individual can not be charged more than amounts generally billed for emergency or other medically necessary care.

Kaleida Health is committed to providing financial assistance to those patients that suffer from financial hardships. Financial Assistance is available to patients of families based on the following income and family size guidelines as determined by the Federal poverty (FPL) regulations as published by The Department of Health and Human Services (HHS).

Size of Family Family Income Less Than:
FPL

200%

200%-249%

250%-299%

300%-349%

400%

1

$25,520

$31,900

$38,280

$44,660

$51,040

2

$34,480

$43,100

$51,720

$60,340

$68,960

3

$43,440

$54,300

$65,160

$76,020

$86,880

4

$52,400

$65,500

$78,600

$91,700

$104,800

5

$61,360

$76,700

$92,040

$107,380

$122,720

6

$70,320

$87,900

$105,480

$123,060

$140,640

7

$79,280

$99,100

$118,920

$138,740

$158,560

8

$88,240

$110,300

$132,360

$154,420

$176,480

Each add’l

$8,960

$11,200

$13,440

$15,680

$17,920

Discount on Charges

100%

90%

75%

60%

50%

Patient Share

0

 

10%

 

25%

 

40%

 

50%

 

Last updated: 03/12/2020

What if I do not meet the income limits?

If you do not meet the income guidelines under the charity care program, Kaleida Health offers a self pay discount and payment plan to all patients.

Can someone explain the self pay discount?

Yes, confidential help is available. Call (716) 859-7200 for information regarding a self pay discount.

Can someone explain the charity care program?

Yes, confidential help is available. Call (716) 859-8979.

Can someone help me apply for charity care assistance?

Yes, confidential help is available. Call (716) 859-8979.

If you do not speak English, someone will help you in your own language.

  • The Facilitated Enroller can tell you if you qualify for free or low-cost insurance, such as Medicaid, Child Health Plus and Family Health Plus.
  • If the Facilitated Enroller finds that you don’t qualify for low-cost insurance, they will help you apply for a charity care discount.
  • The Facilitated Enroller will help you fill out all the forms and tell you what documents you need to bring.

What do you consider assets?

Kaleida Health takes into consideration information from bank statements. We do not include retirement funds, education funds or cars used regularly by you or immediate family members.

What do I need to apply for Charity Care discount?

For Charity Care Assistance, we require four current pay stubs, as well as bank statements not including retirement plans, annuities, etc.

What services are covered?

All medically necessary services provided by Kaleida Health are covered by the Charity Care Program  This includes outpatient services, emergency care, inpatient admissions and nursing home care Charges from private doctors who provide services in the hospital may not be covered. You should talk to the private doctor to see if they offer a discount or payment plan.

How much do I have to pay?

Our Charity Care representative will give you the details about your specific discount(s) once your application is processed.

How do I get the discount?

  • You have to fill out the application form. As soon as we have proof of your income, we can process your application for a discount according to your income level.
  • You can apply for a discount before you have an appointment, when you come to the hospital to get care, or when the bill comes in the mail.
  • Send the completed application to Kaleida Health.

How will I know if I was approved for the discount?

Kaleida Health will send you a letter within 30 days after completion and submission of your application telling you if you have been approved and the level of discount granted.

What if I receive a bill while I’m waiting to hear if I can get a discount?

You cannot be required to pay a hospital bill while your application for a discount is being considered.  If your application is turned down, the hospital must tell you why in writing and must provide you with a way to appeal this decision to a higher level within the hospital.

What if I have a problem I cannot resolve with the hospital?

You may call the New York State Department of Health complaint hotline at 1-800-804-5447.