Plain Language Summary of Financial Assistance Policy
Notice to our Patients and Families:
Thank you for choosing Valley Presbyterian Hospital for your hospital services.
Our hospital requests payments for services upon discharge from the hospital.
A representative from our Patient Access Services (PAS) department will
notify you of your estimated financial obligation, such as insurance co-payments
or self-pay responsibility. This will be addressed and collected during
pre-registration, if scheduled, or during your hospital stay at Valley
For patients who do not have insurance coverage, there are alternative
funding and payment plan options offered by our hospital. Our PAS department
will work with you to identify the best payment option based on government
or hospital rules and regulations.
This packet is designed to provide you information regarding alternate
funding and payment plans offered by our hospital. The following is an
overview of the financial assistance programs provided by our hospital.
Our Financial Assistance Policy, application form, and Plain Language
Summary are all available in English and Spanish.
Medi-Cal and Government Programs
The Medi-Cal Eligibility Program is a hospital service provided to you
at no cost. You may qualify for California Health Benefits Exchange (Covered
California) or other government programs which pay for all or part of
your hospital expenses. You will be given information upon registration
regarding the available plans.
Charity Care Financial Assistance Program
The Hospital will continue to pursue financial recovery options from third
party payers even after all charity write offs are applied. Patients will
not be billed after any 100% charity write off, though may be notified of
collection activities involving third party payers. A Financial Assistance
Program is available to patients that do not have the means to pay for
hospital expenses. You may qualify if your gross household income falls
at or below 350% of the federal poverty level or medical expenses exceed
10% of your annual household income. To be considered for the Financial
Assistance Program, you will be required to provide information on your
household finances through a confidential Financial Application. You must
submit the required documentation within 15 days of receipt of the application.
Documentation will be requested to verify your circumstances. A FAP-eligible
individual can’t be charged more than the amounts generally billed
(AGB) for emergency or other medically-necessary care. Please reference
the attached policy and application for additional information and requirements.
While the FAP does not apply to physician services, patients should be
aware that the Emergency Room physicians of this and every other California
hospital must provide discounted care consistent with California’s
Emergency Physician Fair Pricing Policies Law for eligible patients with
family incomes at or below 350 percent of the FPL. Copies of the free
Financial Assistance Application can be obtained at the Cashiers’
office or Financial Counselors’ office at the hospital, 15107 Vanowen
St., Van Nuys, California 91405, or on this website. For more information
regarding the Financial Assistance Program, or to have the information
mailed to you, please contact the Financial Counselors’ office at
Click here to download in English.
Click here to download in Spanish. Print and fill out. You must submit the required
documentation within 15 days of receipt of the application. Documentation
will be requested to verify your circumstances.
Uninsured Discount Rate
All Uninsured patients are eligible for discounts. The discount is similar
to rates paid by Medicare and is offered to you under our Uninsured Discount Program.
In addition three maternity plans are available. Normal Delivery: Up to
a 2 day stay - $3000; C- Section: Up to a 3 day stay - $5000; C-Section:
4 day stay - $ 6500 – Each additional day for a Normal Delivery
or C-Section is $2000/day; Additional OB Nursery days are $600/day.
If during the admission, you choose to have a circumcision completed on
your child, it is included in the maternity plan. If a decision is made
to perform the procedure on an outpatient surgery basis, the cost will
be calculated based upon the above referenced calculation for outpatient
uninsured discounted rates.
Billing and Payment Plans
If you do not qualify for state assistance or any of our financial assistance
programs, you may establish payment arrangements with our financial counselor.
Payment arrangements may be made with no interest penalties. Defaulting
on your payment plan disqualifies you from taking advantage of this option.
You may receive bills from other billing companies for physician charges,
radiology, ambulance, etc. For assistance regarding policy, questions
or disputes of your hospital bill, please contact the Business Office at
Nonprofit credit counseling service may be available in your area.
Estimate of Charges
In accordance with California law, a written or electronic copy of the
charge master is available at the cashier’s office for medical procedures
and services, or you may call
818.902.2913, Monday through Friday, 8 a.m.to 4 p.m.