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Hospital Details

Policy Effective Date (Date Posted):

General Information

Hospital:

MEMORIAL HOSPITAL LOS BANOS
520 WEST I STREET
LOS BANOS, CA 93635
http://memoriallosbanos.org

License:

General Acute Care Hospital
Total Beds: 46
Emergency Room: Yes
more...

Contact:

Stan Bryda
(209) 572-7172

OSHPD ID:

106240924

Fair Pricing Policy Information Click for FPL Chart

Policy Effective Date: 10/1/1990

Download: Policy File

Federal Poverty Level for Free Care: 200%

Discount Payment Effective Date: 7/1/2006

Discount Payment 1
Federal Poverty Level Range: 201%-400%
Payment Basis:
Medicare
Discount Payment 2
Federal Poverty Level Range: 0%-0%
Payment Basis:

Discount Payment 3
Federal Poverty Level Range: 0%-0%
Payment Basis:

Other Charity Care Discount Payment Information:

In addition to the income-based Financial Assistance set forth below, Memorial Medical Center Los Banos offers financial assistance to insured patients with high medical costs, patients with special financial circumstances such as homelessness or bankruptcy, and patients who are not otherwise covered by health insurance, regardless of income. The guidelines for this assistance are outlined in the attached policy.

Application Form Information

Application Form Eff Date: 12/28/2007

Download: Application File

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: personal property, real estate, alimony and suppor

Language Information

Available Languages:

English
Spanish
Vietnamese
Hmong
Tagalog
Cambodian
Korean
Chinese
Russian
Other: Japanese

Additional Information

Note: To view downloaded .pdf files you will need to install the free Adobe Acrobat Reader. To download the program, please click the image below.

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