# Pacifica Hospital of the Valley

Hospital in Sun Valley, CA. Verified from the hospital's own policy.

Pacifica Hospital of the Valley likely gives free care 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. It likely gives a discount to households with a yearly income up to $79,800 for 1 person, $108,200 for 2, $136,600 for 3, $165,000 for 4, $193,400 for 5 or $221,800 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 | $63,840 | $79,800 |
| 2 | $86,560 | $108,200 |
| 3 | $109,280 | $136,600 |
| 4 | $132,000 | $165,000 |
| 5 | $154,720 | $193,400 |
| 6 | $177,440 | $221,800 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 400% of poverty level, patient pays $0
- 401% to 500% of poverty level, patient pays Medicare DRG rate for inpatient care; 60% off charges for outpatient care

## How to apply

- Call (818) 767-3310 and ask for financial assistance.
- [Application form](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=501a5663-4772-470e-974a-0dc17172a193)
- [Charity Care and Partial Charity Care Discount Policy (effective Jan 1 2024)](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a)
- 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 pay stubs for the three months before you apply, or W-2, Schedule C if self-employed, Social Security, unemployment, or workers' compensation check stubs, checking and savings bank statements, Medi-Cal eligibility or denial notice, if any, proof of dependents may be required.
- Savings and property. The policy counts savings or property, not only income.
- Very large bills. Out-of-pocket costs over 10% of family income in the prior 12 months, for family income up to 500% of the poverty level.
- 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 services provided by Pacifica Hospital of the Valley.

Not covered. Physicians and outside vendors bill separately and are not covered. Cosmetic procedures are excluded from the prompt payment discount.

## 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

Free care at or below 400% of the poverty level for patients who are uninsured and cannot get government coverage. From 401% to 500%, uninsured patients and patients with high medical costs pay the Medicare rate for inpatient care and get 60% off outpatient care. This policy is old. It took effect January 1, 2024, and it still lets the hospital count savings and other money you have, with the first $10,000 and half of the rest not counted. California law since 2025 does not allow hospitals to count monetary assets, so the hospital may follow newer rules than this document shows. Its poverty chart is a blank placeholder for 2022. The application on file with the state is a copy of the policy itself, with no separate form. The policy gives no phone number, so ask for a hospital Financial Counselor. You can apply at any time, even after a bill goes to collections. Approval can be reused for future care for up to six months. Uninsured patients who do not qualify can get 60% off if they pay in full at the time of service or within 30 days. The policy mentions "the AHMC hospitals" in two places, which may be leftover text from another hospital's policy.

## Sources

- Free care level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > A financially qualified patient who has family income at or below 400% of the Federal poverty level will be eligible for a 100% (free) discount
- Discount level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > with a sliding scale discount for financially qualified patients with an individual or family income from 401% to 500% of the Federal poverty level.
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > UP to 500% FPL = Discount to Medicare DRG RATE
- Insured patients https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > A patient with high medical costs can include a person who receives a discounted rate from the hospital because of third-party coverage.
- Asset test https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > In determining eligibility under the charity care policy, PHV can consider a patient’s income and monetary assets.
- Very large bills https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > annual out-of-pocket costs incurred by the patient at PHV that exceed 10% of the patient’s family income in the prior twelve months
- What is not covered https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > Professional services provided by physicians and other services provided by outside vendors are not covered by this policy.
- Deadline https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > Patients may apply (or reapply) for financial assistance at any time in the collection process
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > Paycheck stubs are preferable with income listed for the three consecutive months prior to the month the application is received
- Languages https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=51b2eaaa-0ea5-4e87-a133-4fcc5441093a
  > This policy is available in English and Spanish.

Last checked 2026-11-10.

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