Financial Assistance Summary

The Flushing Hospital Medical Center recognizes that there are times when patients in need of care will have difficulty paying for the
services provided. The Flushing Hospital Financial Assistance Program provides discounts to qualifying individuals based on your
income. In addition, we can help you apply for free or low-cost insurance if you qualify. For further help, please contact our
Financial Office at 718-670-5588 or 718-670-5589. You can also visit us directly at the Flushing Hospital Financial Office, located at
146-01 45th Avenue, 6th Floor, Suite 600, Flushing, NY 11355, for free, confidential assistance.

To obtain a free copy of our Financial Assistance Policy (FAP) and FAP application, you can do any of the following:

• E-mail us at [email protected]
• Go to our website at www.flushinghospital.org and click on the banner for “Financial Assistance” where you will be able to download the FAP and FAP application
• Request information by writing to us at the above address, Attention: Financial Office

Our FAP and FAP application is available in Spanish, Chinese (Traditional and Simplified) and Bengali.

Who qualifies for a discount?

Financial assistance is available for emergency, and non-emergency medically necessary, services to uninsured and under-insured
patients, with incomes up to 400% of the Federal Poverty Level (FPL), who complete a financial assistance application with the
Hospital.

An “under-insured” individual, for the purpose of qualifying for financial assistance is defined as an individual with a household
income up to 400% of the FPL and individual out-of-pocket medical payments accumulated in the past 12 months that amount to 10%,
or more, of the individual’s household gross income.

The program is also available for patients whose medically necessary services are not covered by their health insurance or who have
exhausted their insurance benefits. All qualifying individuals for financial assistance will not be charged more than the amounts
generally billed (AGB) to Medicaid for any emergency or medical services rendered

Everyone residing in New York State who needs emergency services can receive care and get a discount if they meet the income and
eligibility requirements.

For Flushing Hospital, everyone who lives in Queens, the Bronx, Kings (Brooklyn), New York (Manhattan), Richmond (Staten
Island), or Nassau County can get a discount on non-emergency, medically necessary services if they are uninsured and meet the
income and other financial assistance requirements.

You may apply for financial assistance regardless of immigration status.

Cosmetic procedures/services are not covered by the program.

What are the income limits?

The amount of the discount varies based on your income and the size of your family. If you have no health insurance, these are the
income limits: Depending on circumstances, you may qualify for financial assistance even if your income exceeds these limits.

* Based on 400% of the 2025 Federal Poverty Guideline

How much do I have to pay?

The payment amounts for an outpatient service or the emergency room for financial assistance recipients starts from $0 and will
increase depending on your income and family size.

Our Financial Counselors will give you the details about your specific discount(s) once your application is completed and processed.

Generally, payment arrangements (installment plans) will be offered to eligible patients (i.e., those with monthly incomes up to 400%
of the FPL). Monthly installment payments are capped at 5% of the patient’s gross monthly income. Payment arrangements are also
available to patients who demonstrate financial hardship.

Can someone explain the discount? Can someone help me apply?

Yes, free, confidential help is available. Call the Financial Department at 718-670-5588 or 718-670-5589. If you do not speak
English, someone will help you in your own language.

The Financial Counselor can tell you if you qualify for free or low-cost insurance, such as Medicaid, Child Health Plus, Qualified
Health Plan or Financial Assistance.

If the Financial Counselor finds that you do not qualify for low-cost insurance, they will help you apply for a discount. The Financial
Counselor will help you fill out all the forms and tell you what documents you need to bring.

What do I need to apply for a discount?

To apply for financial assistance, you will need a form of picture ID, proof of address, four weeks of pay stubs or last year’s W-2,
and/or a statement indicating how you are supporting yourself or are being supported.

If you cannot provide any of these documents, you may still be able to apply for financial assistance depending on circumstances.

What services are covered?

All medically necessary services provided by Flushing Hospital are covered by the discount. This includes outpatient services,
emergency care, and inpatient admissions.

Charges from private doctors who provide services in the hospital may not be covered. You should talk to private doctors to see if
they offer a discount or payment plan.

How do I get the discount?

You must fill out the application form. As soon as we have proof of your income and family size, insurance status and proof of
medical payments (if applicable), we can process your application for a discount according to your income level.

You can apply for a discount before you have an appointment, when you come to the hospital to get care, or when the bill comes in the
mail.

Send the completed form to the Flushing Hospital Financial Office at 14601 45th Avenue, 6th Floor, Suite 600, Flushing NY 11355 or
bring it directly to the Financial Department at the address indicated.

How will I know if I was approved for the discount?

Flushing Hospital will send you a letter within 30 days after completion and submission of documentation, telling you if you have been
approved and the level of discount received.

What if I receive a bill while I’m waiting to hear if I can get a discount?

You cannot be required to pay a hospital bill while your application for a discount is being considered. If your application is turned
down, the hospital must tell you why in writing and must provide you with a way to appeal this decision to a higher level within the
hospital.

What if I have a problem I cannot resolve with the hospital?

You may call the New York State Department of Health complaint hotline at 1-800-804-5447.

Revised 03/2025