Help Paying Your Bill – Laguna Honda Hospital

Financial Counselors in the Patient Access Admissions & Eligibility Department are here to help you apply for our Charity Care and Discount Payment financial assistance programs that can help you pay your bill.

Contact the Patient Access Admissions & Eligibility Department for more information and to apply. Call (415) 682-5683 to contact a Financial Counselor in the Patient Access Admissions & Eligibility Department, or send a message through your MyChart patient portal.

To be eligible for the Charity Care Program:

• The resident’s family household income may not exceed 500% of the federal poverty level; and
• The resident’s family qualified assets may not exceed $250 at time of service

To be eligible for the Discount Payment Program:

• The resident is not eligible for the Charity Care Program
• The resident’s household federal poverty level determines the amount of the discount to be applied

SFDPH has a single application for both of the Charity Care and Discount Payment programs. Each program has different eligibility requirements, as described below. Residents must provide a completed application and all required verification.

• You must submit a complete application within 12 months from the date of when you received medical care.
• Verification required by each program must be submitted within 30 days of starting an application.
• You may mail an application to the following address: Laguna Honda Hospital and Rehabilitation Center, Patient Access Admissions & Eligibility Department, 375 Laguna Honda Blvd, San Francisco, CA 94116

Applications to Download

• Charity Care and Discount Payment Assistance Application in English
• Charity Care and Discount Payment Assistance Application in Spanish
• Charity Care and Discount Payment Assistance Application in Chinese
• Charity Care and Discount Payment Assistance Application in Russian
• Charity Care and Discount Payment Assistance Application in Filipino
• Charity Care and Discount Payment Assistance Application in Vietnamese

Policy to Download

• Charity Care and Discount Payment Assistance Policy in English

Residents may contact the Patient Access Admissions & Eligibility Department for assistance by:

• Calling (415) 682-5683 – Monday – Friday 8:00 a.m. – 4:30 p.m.
• Sending a message in the request financial assistance section of the resident’s MyChart patient portal account

The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program. 

Go to HospitalBillComplaintProgram.hcai.ca.gov for more information and to file a complaint.