# Stanislaus Surgical Hospital

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

Stanislaus Surgical Hospital likely gives free care to households with a yearly income up to $15,960 for 1 person, $21,640 for 2, $27,320 for 3, $33,000 for 4, $38,680 for 5 or $44,360 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 | $15,960 | $63,840 |
| 2 | $21,640 | $86,560 |
| 3 | $27,320 | $109,280 |
| 4 | $33,000 | $132,000 |
| 5 | $38,680 | $154,720 |
| 6 | $44,360 | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 100% of poverty level, patient pays 0% of the bill
- 101% to 150% of poverty level, patient pays 10% of the bill
- 151% to 200% of poverty level, patient pays 20% of the bill
- 201% to 250% of poverty level, patient pays 30% of the bill
- 251% to 300% of poverty level, patient pays 40% of the bill
- 301% to 400% of poverty level, patient pays 50% of the bill

## How to apply

- Call (209) 572-2700 and ask for financial assistance.
- [Application form](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=87320a6c-ab7c-426f-b049-147d9bb09f02)
- [Charity Care Policy (effective 6/01/2022, next review was due 6/01/2025)](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642)
- 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 the Financial Statement for Financial Assistance, with income, expenses, and debts, a list of bank accounts and other assets (for full charity care), proof of insurance, or any denial of coverage.
- Savings and property. The policy counts savings or property, not only income.

## 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. Non-emergency, medically necessary surgery, inpatient and outpatient.

Not covered. Care that is not medically necessary is not covered, including implants, cosmetic surgery, orthodontics, and lens implants. Services that do not fit a surgical specialty hospital may also be excluded.

## 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 100% of the poverty level. From 101% to 400% the hospital pays part of the bill on a sliding scale, and you pay 10% to 50%. The hospital also works out a minimum amount from your expenses and savings on the application, and bills the larger of the two amounts. This is an old 2022 policy that was due for review in 2025. It still counts savings and other assets and turns down people whose assets are over a limit it does not state. California law since 2025 bars counting savings, so ask the hospital to follow state rules. It also says anyone who got charity care in the past 12 months cannot get it again, and that insured patients may be turned down if their insurer's contract forbids discounts. High medical costs are not defined. The Business Office aims to answer in writing within 3 business days. The file filed as the discount payment policy is a cash discount policy for paying before surgery, at 130% of the Medicare rate. No phone number is printed in the policy or application.

## Sources

- Free care level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > 0-100% 100% 0%
- Discount level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > Your family income is not more than 400 percent of the federal poverty level.
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > 301-400% 50% 50%
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > Patient responsibility, calculated from the table above, is compared to Part 5, Line G of the Application and the greater of the two amounts
- Insured patients https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > You are uninsured (self-pay) OR have high medical costs, AND
- Asset test https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > the patient's total monetary assets exceeds a ceiling, the Applications for full or partial charity care will be declined.
- What is not covered https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > including but not limited to: implants, cosmetic surgery, orthodontics and lens ocular implants.
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=7524856d-592e-44c8-97b5-48d31f18b642
  > A patient requesting charity care must return a completed Application with supporting documentation to Hospital's Business Office
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=87320a6c-ab7c-426f-b049-147d9bb09f02
  > This portion must be completed for all applications for full Charity Care

Last checked 2026-11-10.

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