Patients & Families

Financial Assistance Program

We are honored that you chose Lake Health to provide your care. For over 100 years, Lake Health has provided care to residents in Lake County and surrounding communities. We're committed to treating all of our patients with care and respect, regardless of their ability to pay. To support this mission, Lake Health has established a Financial Assistance Program for patients who are uninsured and who meet certain eligibility criteria. Through this program, Lake Health provides discounts on hospital bills for these patients. 

What financial assistance is available? 

Ohio Hospital Care Assurance Program (HCAP)
As a participant in the HCAP program, we offer emergency and other medically necessary hospital-level services free of charge if you are a resident of Ohio and either (1) you are currently an eligible recipient of the General Assistance or the Disability Assistance Programs or (2) your income is at or below 100% of the Federal Poverty Guidelines (FPG).

Lake Health Assist
In addition to HCAP, Lake Health has a Financial Assistance Policy called Lake Health Assist. This provides financial assistance for emergency and other medically necessary care discounted from our normal charges if you are an uninsured Ohio resident and your income does not exceed four times the Federal Poverty Guidelines (FPG). All applicants will be screened for Medicaid coverage and must cooperate with the Medicaid representatives to be eligible for assistance under our Financial Assistance Policy. The Financial Assistance Policy does not apply to non-Ohio residents, individuals with insurance, Medicaid or Medicaid PE. If you are eligible for financial assistance under our Financial Assistance Policy, you will receive free or other discounted assistance according to the scale below. Payment of the full balance is not required prior to receiving the discount; after a financial assistance discount is applied, the remaining balance will be billed to the patient.

What discounts may be applied? 

Income as compared to Federal Poverty Guidelines (FPG): 

0-250%  

251-400% 

Amount of discount:

 100%

Discounted to Medicare Payment Rate


How can patients apply for financial assistance? 

If you have a representative or family member filling out a financial aid application on your behalf, you will need to complete and return the HIPAA Authorization Form to authorize Lake Health to speak with this person. You may obtain a copy of our Policy and the HCAP and Financial Assistance Applications at the following locations:(i) on this page as a downloadable PDF; (ii) in our admission packet; (iii) in our Emergency Departments; or (iv) in the Financial Counselor’s Office. In addition, if you provide your mailing address to a financial counselor during financial counseling, we will mail you a copy of our Financial Assistance Policy, HCAP Application and Financial Assistance Application free of charge.

Application Process

1. The following steps may be used by Lake Health to determine if an individual is eligible for consideration under the Financial Assistance Policy:

  • A financial counselor may discuss with the patient his/her individual financial position and obtain from the patient information regarding his/her finances. This information will be recorded on the Financial Assistance Application. Patients must sign and complete the Financial Assistance Application in order for it to be evaluated and processed.
  • If the patient qualifies, the financial counselor will work to get the patient’s financial counseling appointment scheduled. The patient will be notified of qualification of assistance, the level of assistance provided or ineligibility.
  • Any financial assistance will apply to all services received by the patient during the month in which Lake Health received the Application for Financial Assistance. An eligibility review will be conducted and a new application will be requested for services outside the dates of approval.
  • If individuals request information regarding financial assistance by phone or email, Lake Health will mail the Financial Assistance Application to the patient or direct them to Lake Health’s website for an online version.
2. Any individual wishing to make application for financial assistance with Lake Health will be given a Financial Assistance Application, which includes written instructions on how to apply.
  • The applicant must fill out a financial disclosure form and provide documentation of proof of income.
  • The applicant must provide evidence of income such as W-2 withholding statements, paycheck stubs, income tax return, forms from Medicaid or other state-funded medical assistance, forms from employers or welfare agencies.
  • The applicant may provide proof that the applicant has other circumstances that indicate financial hardship. Examples include proof of bankruptcy settlement, catastrophic situations (death or disability in family, divorce) or other documentation that shows the patient would be unable to pay medical bills and still be able to pay for other basic necessary expenses.
  • Income shall be annualized from the date of the request, based on the documentation provided and upon verbal information provided by the patient. The annualized amount will also take into consideration seasonal employment and temporary increases and/or decreases to income.
  • If there is a discrepancy between two sources of information, Lake Health may request additional information to support the documentation.
3. An individual has up to two hundred forty (240) days after the issuance of the first billing statement to submit an Application for Financial Assistance. Please note, however, that after the first one hundred twenty (120) days after the issuance of the first billing statement, Lake Health may begin extraordinary collection actions. A Financial Assistance Application is not “submitted” until it is Received and is complete (i.e. does not require any additional information). A Financial Assistance Application is “received” when it arrives at Lake Health’s Financial Counselor’s department. If the application is complete when it is received, it will be deemed submitted. If an Application is incomplete or requires additional information,Lake Health shall notify the applicant and allow for the applicant to complete or provide the requested additional information. Any such additional information must be received within two hundred forty (240) days after the first billing statement has been issued. Only when the application is complete, with any requested additional information if applicable, and received by Lake Health’s Financial Counselor, is the application deemed “submitted.”

4. Consideration for financial assistance will not occur until the applicant has completed the Financial Assistance Application and provided all supporting documentation. Admission/treatment, if deemed medically appropriate, may be deferred until the application process is complete.

5. Lake Health will use its best efforts to determine whether the individual is eligible for assistance within 30 days of receipt of a completed Financial Assistance Application.
  • In the event the individual is eligible for partial waiver of the bill, any remaining balance will still be the responsibility of the patient, and Lake Health will engage in collection efforts.Please note, the patient’s responsibility does not need to be paid in full in order to qualify for the Charity Discount under Lake Health Assist.
6. Lake Health will not waive or apply a discount to any fee that is deemed to be the patient’s responsibility unless an “exception” applies. Such “exceptions” are outlined below:
  • The entire fee is waived and no insurance carrier is billed any amount for the service rendered.
  • The patient is a self-pay with no health insurance benefits.
  • The patient qualifies for a fee waiver or discount after submission of a completed Financial Assistance Application and supporting documentation. Such information must be included in the patient’s medical record and financial/billing records.
7. Any denial of a waiver or discount will be communicated to the patient in writing. If additional documentation of financial need is received and it may qualify the patient for a financial hardship, the additional information should be reviewed and considered in accordance with this policy.
  • Patients who are able to pay for services and are therefore not eligible for financial assistance under this policy may be asked to pay a deposit equal to a percentage of the estimated patient responsibility for either the elective inpatient or outpatient services, prior to being scheduled, and to make arrangements for a payment plan to pay for the remaining balance after services are provided.
8. All information relating to financial hardship requests will be kept confidential.

Learn more about the Financial Assistance Program in these downloadable materials: 

Lake Health Financial Assistance Policy

Lake Health Assist Policy

Hospital Care Assurance (HCAP) Policy

Hospital Care Assurance Application/Financial Assistance Application

Where can I get more information or have a question answered? 

Our Financial Assistance Counselors are ready to help! 

Phone: 440-602-6682
Email: Financial.Counselor@LakeHealth.org