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