Financial Assistance

Citrus Valley Hospital 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 at or below 350% of the current Federal Poverty Limit, and you do not meet the qualifications for Medicaid.

Citrus Valley Hospital Financial Assistance Policy and Financial Assistance Application is available in (English and Spanish) and can be obtained in any of the following ways.

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

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 has financial counselor’s available onsite to assist you with any eligibility questions for local and state Programs, including County and Medicaid.

Financial Assistance Form English

Financial Assistance Form Spanish

Financial Assistance Form Chinese

Charity Care Policy

Collection of Self Paid Patient Accounts Policy