Self-Pay Policy

Our mission is simple: build a healthier community. It’s what we’ve been doing for over 130 years, and today we’re doing it in more ways than ever before.

Self Pay Policy

We offer a discount to self-pay patients that is consistent with discounts from charges provided to other payers. Self-pay quotes require payment in full no later than ten (10) days from discharge or date of service unless prior arrangements have been made.

Financial Assistance discounts will be offered to patients that demonstrate the lack of financial resources to pay the discounted cash price.

We will attempt to obtain specific funds to cover the self-pay price for patients that qualify for those funds.

Policy & Procedure

Self-Pay discounts and policy

Inpatient accounts
On scheduled inpatient accounts, we will quote a price of (discount charges to) 110% of Medicare DRG pricing, (DRG stands for diagnostic related group; procedures are grouped by Medicare and given codes and prices for billing purposes.) with the following exceptions:

  • Maternity accounts
    On scheduled maternity accounts, we have a set fee schedule. In the case of adoptions, arrangements may also be made to reserve an adopting parent suite at a rate of $900 per night.
  • Cosmetic Surgery
    On scheduled cosmetic surgery accounts, we have a set fee schedule. To review Cosmetic surgery fee schedule.
  • Bariatric Surgery
    On scheduled bariatric surgery accounts, we have a set fee schedule.
    Bariatric Fee Schedule: $14,687 which includes pulmonary and endoscopic workups.
  • Inpatient Psychiatric Admission
    Daily per diem rate of $960.00 covers admission to any of the three inpatient psychiatric units (Adult Voluntary, Geriatric, ICU). Daily per diem rate for a private room is $1,260.00. Professional fees not included. All other hospital services included. This does not include inpatient admission for ECT.

Please note that these prices are for your Hospital care only (Technical Component). This does not include the charges made by your own physician or other “hospital-based” physicians such as Anesthesiologist and Pathologist.

Outpatient accounts
On scheduled outpatient accounts, we will quote 35% of estimated charges, with the following exception.

  • Cosmetic Surgery
    On scheduled cosmetic surgery accounts, we have a set fee schedule.

Note: Any payment in excess of 35% of actual charges will be refunded and any payment less that 35% of actual charges will be payable.

Financial Assistance and other discounts:

General relief

General Relief patients usually do not qualify for Medi-Cal, because they are normally single, have no children, are unemployed and homeless. General Relief patients are considered financial assistance eligible patients.

  • The self-pay price of General Relief patient accounts will be given a 100% financial assistance discount.

Financial assistance

Financial Assistance is defined as the demonstrated inability of a patient to pay, versus bad debt as the unwillingness of the patient to pay. To be eligible for a financial assistance discount, the patient’s income must be at or below 350% of the national poverty level. The patient must fill out and sign the Financial Assistance Application.

  • Patients whose income and monetary assets are below 200% of the federal poverty level will receive financial assistance equal to 100% of the self-pay price.
  • Patients whose income is between 201% and 250% of the federal poverty level will receive a financial assistance equal to 75% of the self-pay price.
  • Patients whose income is between 251% and 350% of the federal poverty level will receive a financial assistance equal to 50% of the self-pay price.
  • Patients whose income is between 351% and 400% of the federal poverty level will receive a financial assistance equal to 25% of the self-pay price

Other Funding

Patient Services Assistance (Huntington Hospital Ambulatory Care clinic (HACC) only)

When a patient receiving services from HACC cannot pay the bill, they may qualify for patient services funding. To qualify, the patient must:

  • Live in the immediate area(i.e., Alhambra, Altadena, Arcadia, Duarte, Eagle Rock, Glendale, Monrovia, Pasadena, South Pasadena, Temple City)
  • Apply for financial assistance

Trauma Patients

To obtain trauma funds, Patient Financial Services must have the following:

  • The Trauma Service County Eligibility (TSCE) form must be filled out and signed by the patient or responsible relative/party.
  • If the patient is medically unable to sign and there is no family member available, the “Certificate when Patient Unable to Cooperate form” will be filled out by a financial counselor. A reason why the TSCE form could not be signed will be recorded. The preparer must sign their name on the line for Hospital Reviewer.

Victims of Crime (VOC)

Patients who are a victim of a crime could be eligible for State of California funding from the VOC program. The patient can apply at the District Attorney’s office at the courthouse in Pasadena. The patient will not qualify if:

  • There is insurance involved
  • He/she initiated the crime
  • He/she expires

Itemized Bills

The final bill is normally finalized five days after discharge. The patient can see a summary of charges on the back side of their billing statement or they may obtain a complete itemized bill from the Business Office. For service dates prior to November 6, 2022, call (800) 690-0069. For service dates on or after November 6, 2022, call (866) 803-1777between the hours of 8:00am – 4:30pm, Monday through Friday.