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Hospital Details


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General Information
SIERRA NEVADA MEMORIAL HOSPITAL
155 GLASSON WAY
GRASS VALLEY, CA  95945
http://www.dignityhealth.org/sacramento/hospitals/
General Acute Care Hospital
Total Beds:  104
Emergency Room:  Yes
more... Link to Atlas
Financial Counseling
(530) 274-6227
106291023
Fair Pricing Policy Information   Show FPL Chart
7/1/2021
250%
1/1/2017
Discount Payments:

Discount Payment 1

FPL Range: 251%-350%
Payment Basis:
Medicare

Discount Payment 2

FPL Range: 351%-500%
Payment Basis:
Medicare
Other: Amount Generally Billed

Discount Payment 3

FPL Range: 0%-0%
Payment Basis:
Patients whose income exceeds 500% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Dignity Health facility.
Application Form Information
7/1/2021
Salary Received
Interest Received
Other: Business or Rental Income
Language Information
English
Spanish
Vietnamese
Hmong
Tagalog
Cambodian
Korean
Chinese
Armenian
Russian
Other: Japanese, Arabic, French , Hindi, Portuguese
Additional Information
The attached word document contains the Financial Assistance Policy. This policy outlines the discounts for both 100% Charity Care and other payment discounts.

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