Charity Care Policy

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Consistent with Good Samaritan Hospital Medical Center's mission of providing care to needy persons and underserved persons in a manner that preserves the dignity of the individual, Good Samaritan provides charity care to patients who are unable to pay for all or a portion of their bill. Good Samaritan's provision of charity care is not limited to the Medical Center's primary service area. Emergency services are always provided without regard to the patient's ability to pay. For non-emergent care, no individual will be denied medically necessary hospital services based on a demonstrated inability to pay for those services. Patients who fully cooperate and complete an application for charity care on a timely basis will receive a prompt formal assessment and a written response.

All essential health care services, inpatient and outpatient, shall be available to all individuals under Good Samaritan's charity care policy. Procedures inconsistent with the Ethical and Religious Directives as interpreted and applied by the Bishop of the Diocese of Rockville Centre are specifically excluded from the Medical Center's charity care policy. Non-essential services and services that are not appropriate to a hospital setting may also be excluded from this policy.

Patients without sufficient non-exempt assets qualify for 100% charity care if their family income is at or below 300% of the Federal poverty guidelines. Patients are responsible for 20% to 80% of their bill if their family income is between 300% and 400% of the Federal poverty guidelines. Please refer to the current charity care income guidelines (attached) for sliding scale eligibility percentages. Documentation and verification of income and assets will be requested during the application process.

Good Samaritan recognizes that the need for charity care may be a sensitive and deeply personal issue for recipients. Confidentiality of information and preservation of individual dignity shall be maintained for all who seek charitable services.

If you are interested in applying for financial assistance, you can obtain an application in the admitting department, any outpatient registration area and the emergency department; or you may call (631) 465-6010 for assistance.

Financial assistance Policy

Financial Assistance Application

Please click here for Charity Care Income Guidelines Chart: