Financial Assistance

Citrus Valley Health Partners is committed to making health care available to everyone in our community, regardless of their ability to pay. Our financial assistance program helps low-income, uninsured or under-insured patients who need help paying for all or part of their medically necessary care.

You may qualify for Financial Assistance

You can request financial assistance if your income is less than 500% of the current Federal Poverty Limit, and if not covered by a Third Party insurance or if covered by insurance and is unable to pay the patient liability amount owed after the insurance has paid its portion of the account.

Citrus Valley Health Partners Financial Assistance Policy and Financial Assistance Application are available in (English, Spanish and Chinese) and can be obtained in any of the following ways:

  1. For an electronic copy, please use this link:
  2. To obtain a paper application, get help applying or learn more about our policy, visit our Business Office at 1325 N. Grand Ave. Ste. #300, Covina, Ca. 91724-1016 or by contacting us at 626-732-3100 between 8am and 4pm, Monday through Friday.

Patients determined to be eligible for financial assistance will not be charged for emergency or medically necessary care more than the amount generally billed to our patients who have insurance or Medicare coverage.

Required Documentation

Eligibility alone is not an entitlement to coverage under CVHPs Financial Assistance Program. To determine eligibility and maximize the qualifying assistance/discount amount, the following documents are required when applicable:

  1. Completed & signed financial assistance application
  2. Current pay stub or if self- employed, current year to date profit & loss statement to determine current income.
  3. Recent tax returns or W-2 form
  4. Evidence on any General Relief program benefit, Alimony, Unemployment, Disability, SSI, award letters for social security.
  5. For full charity, last calendar year’s filed tax return with all required schedules to determine generating assets including monetary assets;
  6. For full charity, copies of prior year’s 1099 for interest income, dividends, capital gains, etc.

Financial Counselors

Citrus Valley Health Partners has financial counselors available onsite to assist you with any eligibility questions for local and state Programs, including County and Medicaid.

For questions regarding CVHP’s Financial Assistance Policy or request assistance in completing the Financial Assistance Application, please contact our Business Office at 626-732-3100.

Financial Assistance Form English

Financial Assistance Form Spanish

Financial Assistance Form Chinese

Charity Care Policy

Collection of Self Paid Patient Accounts Policy