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Hospital Details

Policy Effective Date (Date Posted):

General Information

Hospital:

SUTTER MEDICAL CENTER OF SANTA ROSA
3325 CHANATE ROAD
SANTA ROSA, CA 95404
http://www.suttersantarosa.org

License:

General Acute Care Hospital
Total Beds: 135
Emergency Room: Yes
more...

Contact:

Rita Patel
(415) 600-7195

OSHPD ID:

106490919

Fair Pricing Policy Information Click for FPL Chart

Policy Effective Date: 9/1/2004

Download: Policy File

Federal Poverty Level for Free Care: 200%

Discount Payment Effective Date: 12/1/2007

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, Sutter Medical Center of Santa Rosa 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: real estate, personal property, 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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