Financial Assistance - Lourdes | Guthrie (2024)

Lourdes was established by the Daughters of Charity in 1925 to serve the people of this area, especially those in need. Today, we continue our strong commitment to provide services to patients regardless of their ability to pay.

Patients and/or Guarantors are responsible for payment of bills for services provided by, and billed by Lourdes. Lourdes has established the Patient Financial Assistance Program to help patients who meet the income guidelines established by Lourdes. It can also be used to assist with any copays or deductibles of other programs. If we believe that you are eligible for any other program, we will assist you with exploring your options through the Health Insurance Exchange. This enables us to serve as many people as possible with our limited funds. This program is available to the extent Lourdes' resources allow.

A financial scale based on federal poverty level guidelines determines your eligibility for the Patient Financial Assistance Program. How much your Lourdes bill will be discounted depends on how your gross income compares with this financial scale.

If you are found eligible, your discount will apply to all charges generated by Lourdes, except for non-emergency services provided to patients with insurance who have been notified in writing that Lourdes does not participate in their insurance plan. Some services received at Lourdes are provided by private physician groups, such as the services of a Radiologist or Anesthesiologist, and are not covered because the bill you receive is not a Lourdes bill. A Lourdes Patient Financial Counselor will be happy to answer any questions and to help you clarify your charges - just call 607-584-5522.

To Apply for Lourdes Patient Financial Assistance Program

1. Download and Complete the application (PDF)
   • Please include the names and dates of birth for all immediate household members.

     Application Form
     

   • Spanish
   • Chinese (Traditional)
   • Chinese (Simplified)
   • Russian
     
2. Mail the completed application and copies of required proofs to the address at the bottom of the application. We will contact you once your application has been reviewed. If your application is denied, you may appeal this decision to the Health Care Access Committee.

Download Documents

• Amount Generally Billed Calculation
• Financial Assistance Policy
• Financial Assistance Program Summary
• List of Providers Covered by the Financial Assistance Policy
• Self-Employed Form