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Hospital Details

Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

VALLEY MEMORIAL HOSPITAL

1111 E. STANLEY BOULEVARD
LIVERMORE, CA 94550
https://valleycare.com/

License:

General Acute Care Hospital
Total Beds: 75
Emergency Room: Yes
more... Link to Atlas

Contact:

Kristine Grajo, Director, PFS Self Pay
(650) 724-5286

OSHPD ID:

106010983

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

8/1/2016

Download:

Policy File

Federal Poverty Level for Free Care:

400%

Discount Payment Effective Date:

8/1/2016

Discount Payments

Discount Payment 1

FPL Range: 400%-400%
Payment Basis:
Medicare
Medi-Cal
Other Government Insurance

Discount Payment 2

FPL Range: 0%-0%
Payment Basis:

Discount Payment 3

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Scenarios in which FPL is not a criteria for determining the patient's charity care discount is for Special Circumstance Financial Assistance cases: Financial assistance that provides a discount to eligible patients with annualized family income in excess of 400% of the Federal Poverty Guidelines and financial obligations resulting from medical services provided by any SHC entity or provider that exceed 10% of annualized family income. Details are included within the policy.

Application Form Information

Application Form Eff Date:

2/1/2022

Download:

Application File

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: Income Tax Returns

Language Information

Available Languages:

English
Spanish
Vietnamese
Tagalog
Chinese
Russian

Additional Information

Current policy effective July 2020. Updated to include section describing SHC-VC's policy not to engage in any extraordinary collection actions (ECA's) and reference to SHC-VC's Debt Collection Policy. Financial Assistance department location and contact information also updated.

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