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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

ST. AGNES MEDICAL CENTER

1303 EAST HERNDON AVENUE
FRESNO, CA 93720
http://www.samc.com

License:

General Acute Care Hospital
Total Beds: 436
Emergency Room: Yes
more... Link to Atlas

Contact:

Max Hernandez
(559) 448-4668

OSHPD ID:

106100899

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

11/1/2016

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

11/1/2016

Discount Payments

FPL Range: 201%-400%
Payment Basis:
Medicare
Medi-Cal
Other Government Insurance

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

11/1/2016

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: social security, child support

Language Information

Available Languages:

English
Spanish
Other: Language interpreters are listed in policy

Additional Information

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