Help with Your Bill

At Clifton Springs Hospital & Clinic we strive to provide best-in-class healthcare to our friends and neighbors every day.  We do this regardless of an individual's ability to pay, because we understand that everyone's circumstances are different and that our lives - and our financial situations - can change quickly when we encounter issues of injury, accident or poor health.

The links below connect to documents that explain the processes and limitations of the Hospital's ability to provide reduced-cost or free care, based on an individual's situation.

If at any time during your patient experience you have a question about your bill, or your ability to pay it, you are welcome to call our Patient Financial Services staff using one of the following numbers:

        Last names starting with A - K  315.462.0452

        Last names starting with L - Z   315.462.0451

 

The following documents are in .pdf format.  In order to complete them, you will need to print them, complete them, and deliver or mail them.  It is best that you speak with a representative before you complete and submit any materials.

   Financial Assistance Summary

   Financial Aid and Charity Care Application Guide

   Application for Financial Aid

   Authorization for Use of Billing Information

   Payment Plan Agreement

  

  

Patient Financial Services Staff are standing by Monday - Friday from 8:00 am to 4:30 to answer your questions and help you access programs that may reduce or eliminate your out-of-pocket cost of care.