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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

SANTA ROSA MEMORIAL HOSPITAL-MONTGOMERY

1165 MONTGOMERY DRIVE
SANTA ROSA, CA 95405
http://stjosephhealth.org

License:

General Acute Care Hospital
Total Beds: 283
Emergency Room: Yes
more... Link to Atlas

Contact:

Linda Harvey
(971)358-9401

OSHPD ID:

106491064

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

4/1/2023

Download:

Federal Poverty Level for Free Care:

300%

Discount Payment Effective Date:

2/1/2023

Discount Payments

FPL Range: 301%-400%
Payment Basis:
Medicare
Other: Sliding scale Medicare discount

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

4/1/2023

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: See application for details

Language Information

Available Languages:

English
Spanish
Vietnamese
Tagalog
Chinese
Other: See website for details.
Korean
Armenian
Russian

Additional Information

Updated charity care/bad debt policy as well as updated financial assistance application

Family Size	100%	150%	200%	250%	300%	350%	400%