Financial Assistance Program

Patients are encouraged to submit their application for a charity care discount prior to receiving services at Crouse Medical or within 240 days from the completion of the medical practice service. However, Crouse Medical Practice will allow patients to apply for a charity care discount even after their account has gone into a collection status.

You may download the application and self attestation income form here or contact our Financial Counseling Department at 315-470-5825 to have an application mailed out to you.

Applicants for charity care may be screened for Medicaid eligibility by a Crouse Medical Practice Financial Counselor. Charity Care applications must be completed with proof of income or self attestation if no documented proof of income is available. Eligibility for a discount is based upon households with incomes up to 340% of the Federal Poverty Level. Please see Charity Care Discount Guidelines at the bottom of the page.

Consideration for charity care will apply to eligible services that are considered essential health services provided and billed under Crouse Medical Practice. Charity care discounts are also available to patients to decrease the cost of coinsurance, co-payments and deductibles.

Charity care discounts are available to patients who are residents of New York State only. For uninsured patients residing outside of New York State and who receive services at Crouse Medical Practice a self-pay discount of 30 percent off charges is available.

A determination will be based on information provided. You will be notified in writing of the determination.

• 100% approval or a small nominal fee.
• Partial Approval: Those who have been accepted and who have income between 101 percent and 340 percent of the federal poverty guidelines will receive a partial sliding scale discount based on an amount generally billed reimbursement rate.
• Denial: Denials are based on information provided by the patient and will be specific as to what Charity Care eligibility the patient did not meet.

Certainly – Crouse Medical Practice accepts payment arrangements. A Crouse Medical Practice representative will assist you in the payment arrangements to be set up based on your income and the balance of the bills.

Yes, if approval is made any discount awarded will be applied to coinsurances, co-payments and deductibles.

Yes, translator services are available to assist with the application process. To request translator assistance please ask a Crouse Medical Practice representative.

For help with the charity care application process please contact a representative at 315-470-2939. We are here to assist you any way we can.

To apply for charity care, please fill out an application and send to:

Crouse Medical Practice
Attn: Financial Counseling
730 S Crouse Ave, Suite 204,
Syracuse, NY 13210

Phone: (315) 470-5825
Fax: (315) 470-2919