# Mountains Community Hospital

Hospital in Lake Arrowhead, CA. Verified from the hospital's own policy.

Mountains Community Hospital likely gives free care to households with a yearly income up to $31,920 for 1 person, $43,280 for 2, $54,640 for 3, $66,000 for 4, $77,360 for 5 or $88,720 for 6. It likely gives a discount to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $31,920 | $63,840 |
| 2 | $43,280 | $86,560 |
| 3 | $54,640 | $109,280 |
| 4 | $66,000 | $132,000 |
| 5 | $77,360 | $154,720 |
| 6 | $88,720 | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 200% of poverty level, patient pays uninsured: $0 (full charity care); insured: 40% of what you owe after insurance
- 201% to 225% of poverty level, patient pays uninsured: 20% of the Medicare amount; insured: 60% of what you owe after insurance
- 226% to 250% of poverty level, patient pays uninsured: 40% of the Medicare amount; insured: 60% of what you owe after insurance
- 251% to 275% of poverty level, patient pays uninsured: 60% of the Medicare amount; insured: 80% of what you owe after insurance
- 276% to 400% of poverty level, patient pays uninsured: 80% of the Medicare amount; insured: 80% of what you owe after insurance

## How to apply

- Call (909) 436-3125 and ask for financial assistance.
- [Application form](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=3541a284-4bd7-440d-8dfc-9a70aa5877a7)
- [Charity Care and Discount Payment Policy, version 5 (approved 10/30/2025; on file with HCAI 06/22/2026)](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16)
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.
- Bring signed federal income tax return (Form 1040) with all schedules, or two recent pay stubs and a letter explaining why you did not file taxes, a letter explaining how you support yourself if you have no income.
- Very large bills. Above 400% of the poverty level, a catastrophic medical event may be considered case by case at the hospital's discretion
- Languages. English, Spanish

## If you have insurance

Insured patients can also apply for help with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## What is covered

Covered. Medically necessary inpatient and outpatient services, including hospital charges and professional fees billed by the hospital.

Not covered. Doctors who bill separately, such as emergency room doctors and radiologists, are not covered. Emergency room doctors must give their own discounts up to 400% of the poverty level.

## State program in California

### Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)

Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.

Income levels in the program are discount up to 400% of poverty level.

Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.

How to apply. Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).

> Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/frequently-asked-questions/, checked 2026-11-10

### Hospital Bill Complaint Program (HCAI)

A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.

Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.

How to apply. File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.

> If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/, checked 2026-11-10

### Emergency physician discount rule

Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.

Income levels in the program are discount up to 400% of poverty level.

Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.

How to apply. Ask the emergency physician group named on the bill for its discount payment policy.

> an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care

Source https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=c7bdd7eb-bcc0-4a84-bcab-a21b5e578d9c, checked 2026-11-10

## Notes

Uninsured patients get free care at or below 200% of the poverty level. From 201% to 400% they pay a share of what Medicare would pay, from 20% up to 80%. Insured patients get no free tier. Below 200% they pay 40% of what they owe after insurance, and the share rises to 80% up to 400%. Total payment from you and your insurer is capped at what Medicare or Medi-Cal would pay. Above 400% the hospital may help case by case after a catastrophic medical event, and it looks at income and assets then. Homeless patients, patients who died with no estate, and patients declared bankrupt in the past 12 months qualify for charity care. Eligibility can be decided any time the hospital has your income papers. Appeals go in writing to the CFO, whose decision is final. Mail the application to the Eligibility Office, P. O. Box 70, Lake Arrowhead, CA 92352. The policy does not say whether savings are counted for regular charity care or discounts.

## Sources

- Free care level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > If an uninsured patient's family income is 200% or less of the FPL at the time of the first billing
- Discount level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > If an uninsured patient's family income is between 201% and 400% of the FPL at the time of first billing
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > 201 - 225% 20% 226 - 250% 40% 251 - 275% 60% 276 - 400% 80%
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > Less than 200% 40% of patient portion due 201 - 250% 60% of patient portion due 251 - 400% 80% of patient portion due
- Insured patients https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > If an insured patient's family income is between 0% and 400% of the FPL at the time of first billing
- Very large bills https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > Any patient whose income exceeds 400% of the FPL and experiences a catastrophic medical event may be deemed eligible for financial assistance.
- What is not covered https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > It does not apply to fees billed by Physicians who are separate from the Hospital such as Emergency Room physicians and Radiologists.
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=3541a284-4bd7-440d-8dfc-9a70aa5877a7
  > Two (2) recent paystubs within a 6-month period before or after the patient is first billed by the hospital
- Languages https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=74813316-2be2-4534-ad20-20a87584cf16
  > Charity Care notices are posted in English and Spanish
- Financial counseling phone https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=3541a284-4bd7-440d-8dfc-9a70aa5877a7
  > If you have questions, please call the Eligibility Office at (909) 436-3125.

Last checked 2026-11-10.

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