| Title | Size |
|---|---|
| Financial Assistance Application | 70.50 KB |
| Financial Assistance Policy - English | 56.58 KB |
| Financial Assistance Policy - Polish | 71.52 KB |
| Financial Assistance Policy - Spanish | 67.65 KB |
| Independent Service Providers - A-II | 161.14 KB |
| Plain Language Summary | 34.90 KB |
| Resumen de Asistencia Financiera | 47.12 KB |
| Services Covered by Financial Aid Providers - A-I | 98.01 KB |
| Solicitud de Asistencia Financiera | 66.67 KB |
Peconic Bay Medical Center provides charitable assistance for people in need.
Those seeking charitable assistance must meet certain income guidelines. In order to be considered for the program, you must be uninsured or underinsured (benefits exhausted) and have a family income at or below 500% of the Federal Poverty Level. Eligibility and assistance is based on family income and size.
To determine eligibility and the appropriate level of financial assistance, the patient must submit documents verifying family size and income.
Such documents may include the following:
- The applicant's prior year's W-2 form
- Current pay stubs
- Written verification of wages from your employer
- Unemployment letter
- Social Security Check
- Birth Certificate
- Marriage Certificate
- Death Certificate
- Separation Papers
- Social Security Cards
- Additional documents may be requested.
This documentation should be forwarded to:
Peconic Bay Medical Center Financial Assistance Coordinator 1300 Roanoke Avenue Riverhead, NY 11901
If you have any further questions, please contact Peconic Bay's Financial Aid Representative at 631-548-6099, Monday-Friday, 9 am - 5 pm
Si tiene alguna pregunta referente a su factura y necesita de los servicios de interprete en espanol, por favor llame al 631-548-6758 para obtener ayuda.