Financial Assistance Policy - -

Financial Assistance Policy

Crozer Keystone Health System (CKHS) Financial Assistance Policy/Program (FAP) exists to provide eligible patients, partially or fully-discounted emergency or other medically necessary healthcare services provided by CKHS and a substantially related entity (as defined by the IRS). CKHS and any substantially related entity are hereinafter referred to as CKHS. Patients seeking Financial Assistance must apply for the program, which is summarized herein.

Eligible Services: Emergency or other medically necessary healthcare services provided by CKHS and billed by CKHS. The FAP only applies to services billed by CKHS. Other services which are separately billed by other providers, such as physicians or laboratories, are not eligible under the FAP.

Eligible Patients: Patients receiving eligible services, who submit a complete Financial Assistance Application (including related documentation/information), and who are determined eligible for Financial Assistance by CKHS

How to Apply: FAP and related Application Form may be obtained/completed/submitted as follows:

  • In person at any CKHS hospital patient access departments or Emergency Room desk.
  • Request documents be mailed to you, by calling CKHS Financial Resource Center at 610-447-2336
  • Request documents by mail/or visiting in-person: CKHS Financial Resource Center located at One Medical Center Blvd Upland PA 19013. Visiting In-person, Enter through the Out Patient Entrance (Park in the Upland Garage) upon entering through the outpatient entrance walk straight to the Financial Resource Center located in the first room on your right. (The CKHS Financial Assistance Policy is also available upon request by mail, or in person, at this location.)
  • Download the documents from the CKHS website:
  • Mail completed applications (with all documentation/information specified in the application instructions)to: CKHS
    • Attn: Financial Resource Center, One Medical Center Blvd., Upland, PA 19013; or deliver in person to CKHS Financial Resource Center, One Medical Center Blvd. Upland PA 19013. This office is located inside the Outpatient Entrance (park in the Upland garage) upon entering the outpatient entrance walk straight to the Financial Resource Center located in the first room on your right. Please call 610-447-2336 for further directions.

Determination of Financial Assistance Eligibility: Generally, Eligible Persons are eligible for Financial Assistance, using a sliding scale, when their Family Income is at or below 400%of the Federal Government’s Federal Poverty Guidelines (FPG). Eligibility for Financial Assistance means that Eligible Persons will have their care covered fully or partially, and they will not be billed more than “Amounts Generally Billed” (AGB) to insured persons (AGB, as defined in IRC Section 501(r) by the Internal Revenue Service). Financial Assistance levels, based solely on Family Income and FPG, are:

  • Family Income at 0 to 200%of FPG - Full Financial Assistance; $0 is billable to the patient.
  • Family Income above 200% to 400% of FPG - Partial Financial Assistance; AGB is maximum billable to the patient.

Note: Other criteria beyond FPG are also considered (i.e., availability of cash or other assets that may be converted to cash, and excess monthly net income relative to monthly household expenditures), which may result in exceptions to the preceding. If no Family Income is reported, information will be required as to how daily needs are met. CKHS financial counselors review submitted applications which are complete, and determines Financial Assistance Eligibility in accordance with CKHS Financial Assistance Policy. Incomplete applications are not considered, but applicants are notified and given an opportunity to furnish the missing documentation/information.

CKHS also translates its FAP, FAP application form and the plain language summary of its FAP in other languages wherein the primary language of the residents of the community served CKHS represents 5 percent or 1,000; whichever is less; of the population of individuals likely to be affected or encountered by CKHS. Translated versions available upon request in person at the address below; and on the CKHS website

For help, assistance or questions please visit or call: CKHS Financial Resource Center located at one Medical Center Blvd. Upland PA 19013 Visiting In-person, park in the Upland Garage and enter through the outpatient entrance walk straight to the first room on your right. If you need further directions or have questions please call the financial resource center at 610-447-2336 Monday through Friday from 8:30 AM to 5:00 PM.

To review the complete Financial Assistance Policy, please click here.

To download a PDF copy of the Financial Assistance Policy, please click here.

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