It is the policy of Bristol Hospital and Health Care Group, Inc. DBA Bristol Health, to provide financial assistance to eligible patients who have difficulty paying for emergency and other medically necessary health care services. Regardless of eligibility for such financial assistance, Bristol Health will provide care, without discrimination and without regard to payor source, for emergency medical conditions in accordance with EMTALA and Bristol Health's emergency medical treatment policy.
This policy applies to Bristol Hospital and the following affiliates: Bristol Hospital Multi-Specialty Group, Bristol Hospital EMS LLC, Bristol Health Inc. DBA Ingraham Manor, and Bristol Homecare and Hospice Agency, Inc.
Click here to read the full Financial Assistance Policy.
Eligibility Requirements and Assistance Offered
Financial assistance and discounts are available for emergency or other medically necessary services provided by Bristol Health.This policy is designed to provide the appropriate level of financial assistance to the greatest number of eligible patients who are truly in need while at the same time ensuring that Bristol Health has the resources available to serve its community.
- Uninsured patients who are U.S. citizens and have resided for at least 1 year in Bristol Health’s primary or secondary service area are eligible to apply to the FAP for financial assistance. In addition, uninsured lawful non-U.S. citizen residents who meet the 5 year residency requirement for Connecticut Medicaid and who have resided in the identified service areas for at least 1 year may also apply to the FAP.
- Bristol Health’s primary and secondary service areas consist of the following towns: Bristol, Plainville, Plymouth, Terryville, Burlington, Farmington, Southington, Harwinton, Thomaston and Wolcott.
- Any patient who does not fall into any of the categories described above may qualify for financial assistance if the patient receives EMTALA services and is determined to be eligible for financial assistance based on review of income, assets and other criteria set forth in this Policy.
- Financial assistance for services eligible under this policy may be made available to the uninsured patient on a full or partial basis based on family size and federal poverty levels (FPL) using the FPG in effect at the time of the determination. An uninsured patient whose income is less than or equal to 250% of FPL and meets all other criteria for eligibility, will be entitled to a 100% discount. Eligible uninsured patients with income up to 400% of FPL will be entitled to a sliding scale discount set forth in Appendix B.
- A patient with insurance where the insurance company does not include Bristol Health as a participating provider will be considered as self-pay. As such, a deposit of 33% of estimated charges will be required before the patient is registered or scheduled for a non-emergency service, and financial assistance will not be provided.
- Financial assistance is not considered to be a substitute for patient responsibility. Patients are expected to cooperate with Bristol Health's FAP application procedures and to contribute to the costs of their care based on ability to pay.
In order to be considered for financial assistance, the patient must complete a Financial Assistance Application and provide certain financial information and other documentation that may be requested for determination of eligibility under the FAP.
Bristol Health will attempt to assist all patients registered as “self-pay” with identifying and securing coverage, and/or establishing a payment plan for amounts determined to be a patient responsibility prior to receipt of medically necessary health care services and will provide any self-pay patients who may not be able to secure coverage or pay for the service with information about the FAP and the application process.
If you have an upcoming procedure or diagnostic service that has been scheduled with Bristol Health, you may request further information about our cost and quality. An estimate of what the allowable amount is for your scheduled service can be provided to you within 3 business days. Please contact the following number for further information:
Financial Counseling: 860.585.3035
You can also visit us in-person. We are located on Level E of Bristol Hospital, 41 Brewster Road, Bristol, CT.
The following websites are available to any person wanting to obtain information on specific quality indicators and how well our hospital is rated. They are available to every patient. No user name or password is required to log on to these websites.
1. The Hospital Compare site allows the user to compare performance on quality measures of specific hospitals in the state and nationally. A star rating is assigned to each individual hospital based upon performance.
2. The Quality Check site is sponsored by the Joint Commission. This site assists the consumer in locating those organizations that have achieved the Gold Seal of Approval throughout the state and nationally.
Downloadable Documents & Forms
Full Financial Assistance Policy
Financial Assistance Policy Appendix B
Financial Assistance Application
Required Documents List
Master Price Guide