Patient Financial Assistance Program

Phone: 607-584-5522

Lourdes was established by the Daughters of Charity in 1925 to serve the people of this area, especially those in need. Today, we continue our strong commitment to provide services to patients regardless of their ability to pay.

Patients and/or Guarantors are responsible for payment of bills for services provided by Lourdes. Lourdes has established the Patient Financial Assistance Program to help patients who meet the income and resources guidelines established by Lourdes, and who are not eligible for any other available program, such as Medicaid, Child Health Plus, Family Health Plus, etc. It can also be used to assist with any copays or deductibles of other programs. If we believe that you are eligible for any other program, you must apply to that program and receive in writing, an approval or denial before we can determine if you are eligible for the Lourdes Patient Financial Assistance Program. This requirement enables us to serve as many people as possible with our limited funds. This program is available to the extent Lourdes' resources allow.

A financial scale based on federal poverty level guidelines determines your eligibility for the Patient Financial Assistance Program. How much your Lourdes bill will be discounted depends on how your gross income and resources compare with this financial scale.

• Scale is based on the Federal Poverty Level for 2013.

• Gross income of individual or family is used.

• Pregnant women are considered as two people.

If you are found eligible, your discount will apply to all charges generated by Lourdes. Some services received at Lourdes are provided by private physician groups, such as the services of a Radiologist or Anesthesiologist, and are not covered because the bill you receive is not a Lourdes bill. A Lourdes Patient Financial Counselor will be happy to answer any questions and to help you clarify your charges.

To Apply for Lourdes Patient Financial Assistance Program:

1. Download and Complete the application (PDF).
2. Please include the names and dates of birth for all immediate household members.
3. Provide proof of total household income. Copies of pay stubs for the most recent four week period, or a letter from your employer stating monthly gross wages. Include unemployment printout from website, Social Security benefits, monthly pension or any other sources of monthly income.
   
   If you are self-employed, please download, print and complete a Financial Status form to include with your Patient Financial Assistance Program application. 
4. We also need proof of any resources you may have.  Resources include checking/savings accounts, stocks, bonds and real estate property other than your primary residency. We do not include your home, tax deferred retirement or college savings funds, or vehicles used by your immediate family.
5. Mail the completed application and copies of required proofs to the address at the bottom of the application. We will contact you once your application has been reviewed. If your application is denied, you may appeal this decision to the Health Care Access Committee.

If you wish to speak with a financial counselor contact the cashiers office at Lourdes Hospital at 607-584-5522.

Please note:

• You do not need to schedule an appointment to meet with a Financial Counselor. You are welcome to walk in anytime between 8:00 AM and 4:00 PM, Monday - Friday to receive assistance completing your PFAP application. Financial Counselors are available at two locations: 
   
• • Lourdes Hospital, Financial Assistance Office, Ground Floor, 
    169 Riverside Drive, Binghamton, NY
  • Lourdes Business Center, 33 Lewis Road, Binghamton, NY

• It takes up to 30 days to process your PFAP application.
• Applications are processed in the order in which they are received.
• If we have questions about your application, we will call you.
• If we do not have all the information necessary to process your application, the application will be returned to you with a request to provide additional information.
• You will receive written notification regarding the outcome of your PFAP application.
• If you receive a denial letter, please feel free to contact Sue at 607-798-5506 for information about the appeal process.

In accordance with our Mission and Values, Our Lady of Lourdes Memorial Hospital, Inc. is committed to caring for all people regardless of their ability to pay, with special attention to those who are poor and vulnerable. Our Lady of Lourdes Memorial Hospital, Inc. offers financial counseling and assistance to help address any financial concerns patients or families may have regarding their care. Our financial aid policies, which can be found here on our website or by visiting our Patient Financial Assistance office, located on the ground floor of Lourdes Hospital reflect Our Lady of Lourdes Memorial Hospital, Inc.'s dedication to working together with our patients in a compassionate and caring manner to identify options for resolving their financial obligations. Help is available by contacting the Financial Assistance office at 607-584-5522, by emailing info@lourdes.com, or in person at any of our facilities.