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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

CASA COLINA HOSPITAL

255 EAST BONITA AVENUE
POMONA, CA 91767
http://CasaColina.Org

License:

General Acute Care Hospital
Total Beds: 99
Emergency Room: Yes
more... Link to Atlas

Contact:

Lynn DeJohn
(909) 596-7733 Ext. 2155

OSHPD ID:

106190137

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

1/1/2011

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

1/1/2011

Discount Payments

FPL Range: 201%-250%
Payment Basis:
Other: Patient is responsible for 25% of total bill.

FPL Range: 251%-300%
Payment Basis:
Other: Patient is responsible for 50% of total bill.

FPL Range: 301%-350%
Payment Basis:
Other: Patient is responsible for 75% of total bill.

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2011

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received

Language Information

Available Languages:

English
Spanish

Additional Information

01/01/2012 There are not changes to the the posted documents.

Family Size	100%	150%	200%	250%	300%	350%	400%