Patient Financial Assistance Program
At St. Jude Medical Center, we are proud of our mission to provide quality care to all our patients, regardless of ability to pay. We believe that no one should delay seeking needed medical care because they lack health insurance or are worried about their ability to pay for their care. That's why we have a Patient Financial Assistance Program that provides free or discounted services to eligible patients. Reasonable efforts will be made to notify patients that they may qualify for financial assistance and how to apply.
What is the Patient Financial Assistance Program?
Our Patient Financial Assistance Program helps to make our services available to everyone in our community. This includes people who don't have health insurance and can't pay their hospital bill, as well as patients who do have insurance but are unable to pay the portion of their bill that insurance doesn't cover.
In some cases, eligible patients will not be required to pay for services; in others, they may be asked to make partial payment.
Who Is Eligible?
Patients who are uninsured and do not qualify for government-sponsored insurance programs, and with family income up to 500 percent of the Federal Poverty Guidelines may be eligible for our program. Our financial counselors, in the admitting department or the patient financial service office, will work with you to determine if you qualify. Please remember that access to necessary healthcare is not affected by eligibility for financial assistance. St. Jude Medical Center is committed to treating all those who come to us for care.
How to Apply
We know that hospital stays can be stressful both for the patient and his or her family, so we try to make applying for the Patient Financial Assistance Program as easy as possible. We offer two ways to apply. Patients can download the Patient Financial Assistance Application in English or
Spanish, print it, complete it and return it to us by mail.
How to complete the Application for Financial Assistance:
- Please print the patients name in the location Patients Name
- If you know the patient's Medical Record Number, please enter it in location [detailed location information]#
- Please enter the date the application is being completed in the date location
- If the patient is a minor (under 18 years of age) please print the responsible party that is completing the application on their behalf in the [detailed location information] Location
- If the patient is a minor (under 18 years of age) please list the relationship to the patient of the responsible party completing the application in the Relationship to Patient Location
- Please enter the patients current address in the Address location
- Please enter a valid phone number for the patient in the Telephone location
- Place a check mark in the location beside Are you a US Citizen, if you are a US Citizen if not leave this space blank
- Please place a check mark in the field next to Are you a CA/TX Resident if you are a resident of the given state on your application, if not please leave this field blank
- Please place a number in the blank beside the Total Household Size
- Please place a number in the blank beside Total # of Dependents, this should reflect the total number of children living in the household that the patient/applicant is responsible for
- In the boxed section please list fill out a line to include Name, Birthdate, Relationship to the patient, and gross income for that person listing the income to be either weekly, monthly or yearly
- Each column should be completed for the total number of people listed in the household
- This information should correlate with the Total Household Size listed on the application
- Please print your name validating that the information provided is correct, date and sign
- The bottom line will be completed by hospital staff
- In order to completed your application acceptable income verification will need to be provided
- If you have no income, a denial of Medicaid eligibility is required.
Mail the application along with the required documents to:
St. Jude Medical Center
Patient Financial Services Department
ATTN: DENISE ORTIZ
PO BOX 4138
Fullerton, Ca 92834-9973
If you have any questions, please contact our Customer Service Department at 1-800-378-4189.