Financial Assistance

Financial Assistance Program

About Financial Assistance Program:

Nathan Littauer Hospital recognizes that there are times when patients in need of care will have difficulty paying for the services provided.  Nathan Littauer Hospital’s Financial Assistance Program provides discounts to qualifying individuals based on income. If you have any questions, please call 518-773-5558.  In addition, we can help you apply for free or low-cost insurance if you qualify.  Just contact our Navigational Enrollment staff at (518) 775- 4074 or go to our Care Coordination Suite for confidential assistance.

Download the NLH Financial Assistance Brochure (PDF) ▼
Download the NLH Financial Assistance Policy (PDF) ▼
Download the NLH Financial Assistance Summary (PDF) ▼

Apply Now:

Read our Financial Assistance Program Policy Statement below, download and print the Application and Instructions, and return to Nathan Littauer Hospital.

Policy Statement:

The hospital, as a provider of emergency and medically necessary care, has a mission and a responsibility to provide such care to those patients in need. It is the practice of the hospital that the fear of a hospital bill should not prevent a potential patient from receiving essential health services. The hospital will maintain financial assistance policies that are consistent with its mission and values, taking into account each patient’s ability to pay for services while considering the hospitals financial ability to provide care.
In an effort to ensure that Nathan Littauer Hospital provides health care services to the sick and afflicted regardless of ability to pay, we have adopted a standard Financial Assistance Program. Nathan Littauer Hospital & Nursing Home will make available Financial Assistance Program to our Primary Service Area, which is defined by the following counties, Fulton, Hamilton, Herkimer, Montgomery and Saratoga. The Financial Assistance Program is part of Nathan Littauer Hospital’s overall Financial Counseling and training curriculum, which in part educates our staff to identify patients that can benefit from our Financial Counseling services and Financial Assistance.  Our Financial Counseling and Financial Assistance Program Policies will assist Nathan Littauer Hospital & Nursing Home in promoting financial health, which enables us to continue our mission of providing high quality of health and wellness services and improving the health of our communities in a caring, contemporary environment.



1. Financial Assistance – a Nathan Littauer Hospital program through which medically necessary and preventative services are provided at a reduced cost or without charge when it has been determined that payment for those services cannot be obtained through insurance, outside agencies, or private means.

2. Financial Counseling – a process of working together with our patients in a compassionate and caring manner to identify options for resolving their Nathan Littauer Hospital financial obligations.

3. Guarantor – A guarantor is a person age 18 or over, regardless of marital status, who has legal financial responsibility for services provided to him/her and/or his/her legal minor children.

4. Household – includes the following people living in the same home:

  • Guarantor
  • Guarantor’s spouse
  • Guarantor’s children/minor dependents and step-children (i.e. children living with grandparents that are legal guardians)
  • Guarantor’s unmarried partner, if they have a child(ren) in common. If they have a child(ren)in common, the unmarried partner’s child(ren) from previous relationships also qualify if living in the home
  • A household does not include any of the following people:
  • Roommates, extended family members, such as aunts, uncles, cousins, parents, etc.
  • The Guarantor’s unmarried partner, if they don’t have a child together, nor the unmarried partner’s other child(ren) from a previous relationship

5. Income – Total receipts before taxes, from all sources, including wages, self- employment income, retirement, workers compensation, strike benefits, alimony, child support, military allotments, dividends, interest and rent.

6. Medical Necessity – Medically necessary care is the care that, in the opinion of the treating physician/clinician, is reasonably needed:

  • To prevent the onset or worsening of an illness, condition, or disability;
  • To establish a diagnosis;
  • To provide palliative, curative or restorative treatment for physical, behavioral and/or mental health conditions; and/or
  • To assist the individual to achieve or maintain functional capacity in performing daily functional capacities that are appropriate for individuals of the same age.

Each service must be performed in accordance with standards of medical practice generally accepted at the time the services are rendered. Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose.

Relevant Forms:

  1. Financial Assistance Program Application and Instructions (Spanish Version)
  2. Approval Letter
  3. Denial Letter
  4. Clarification Letter
  5. Response to an Appeal Letter

Financial Assistance Overview:

  1. Financial Assistance is secondary to all other financial resources available to the patient, including but not limited to insurance, third party liability payers, government programs, and outside agency programs.
  2. Financial Assistance is granted for medically necessary and preventative services only.
  3. Financial Assistance determination and approval process will be the same regardless of the amount of the patient’s balance.
  4. Patients may apply for Financial Assistance before, during, or after treatment or at any time during the billing and collection process.
  5. Signage and brochures have been developed to inform patients about Nathan Littauer Hospital’s Financial Counseling Programs and Financial Assistance Program. These must be placed at all appropriate access areas, including registration areas.

Financial Assistance Program Eligibility and Determination:

  1. The provision of necessary healthcare shall never be delayed by an assistance determination. Emergency care should never be delayed by requests for financial or other information regarding ability to pay.
  2. Financial Assistance is not granted for elective cosmetic surgery or other special situations, such as that of an individual who is eligible for insurance or government programs but has refused to apply.
  3. Requests for Financial Assistance may be made at any point before, during or after the provision of care. Anyone seeking Financial Assistance will be given an application. Financial Assistance Program requests may be proposed by sources other than the patient, such as the patient’s physician, family members, social services, or hospital personnel. Pending final eligibility determination, Nathan Littauer Hospital will not initiate collection efforts or requests for deposits provided that the responsible party is cooperative with Nathan Littauer Hospital’s efforts to get payment from other sources. If initial screening does not disqualify someone for the Financial Assistance Program they will be given an application, which includes instructions on how to apply.
  4. Consideration for the Financial Assistance Program will occur once a completed application has been submitted to Nathan Littauer Hospital.
  5. Consideration for the Financial Assistance Program includes a review of the responsible party’s annual household income and the number of people in the home. Subject to any governmental requirements securable assets (including primary residence, family’s primary mode of transportation, and retirement accounts), special medical costs, reasonable living expenses, credit history, existing debt, and other indicators of the party’s ability to pay will not be utilized in making a determination of eligibility.
  6. Financial Assistance shall be granted to all applicants whose annual incomes fall at or below 100% of the current Federal Poverty Levels. Financial Assistance Program may also be awarded to applicants whose annual income falls at or below 300% of current Federal Poverty Level (FPL). Assets will not be considered for these applicants.
  7. The Federal Poverty Levels will be revised in conjunction with the FPL updates published by the Center for Medicare and Medicaid Services.
    Percentage Federal Poverty LevelPercentage of Financial Assistance
  8. Acceptable verification of income includes proof of all income for the past 4 weeks, including payroll stubs, Social Security or unemployment benefits, brokerage account statements; most recent year’s tax return. An Income Statement for self-employed applicants is required.
  9. Nathan Littauer Hospital will return to the responsible party written notice of its assistance determinations within 30 calendar days of receiving a completed Financial Assistance Program Application. This notification will include the level of reduction and reasonable payment arrangements consistent with the responsible party’s ability to pay.[1] Denials will include the reason for denial and instructions for appeal or reconsideration.
  10. If an incomplete application is returned to Nathan Littauer Hospital, a letter will be sent to the responsible party explaining what is required. The incomplete Financial Assistance Program Application will be pended for 30 days awaiting receipt of requested additional information.
  11. Accounts in collection may be eligible for Financial Assistance for the following reason(s):
    • A completed application is received within the specified 240 days from first billing statement.
  12. Nathan Littauer Hospital will keep all Financial Assistance Program Applications and supporting documentation confidential. Nathan Littauer Hospital may, at its own expense, request a credit report to further verify the information on the applications. Conflicting information between the credit report and the application may result in a denial or request for additional information.
  13. A responsible party may be considered for Financial Assistance without a completed Financial Assistance Program Application if sufficient information can be obtained that allows for final determination.


The responsible party may appeal the determination of eligibility for Financial Assistance by submitting in writing additional information, such as income verification or an explanation of extenuating circumstances, to the Patient Financial Services Manager within 45 days of the denial notification. The Patient Financial Services Manager will review all appeals and make a final determination. If this determination affirms the previous denial of Financial Assistance, written notification will be sent to the responsible party. Collection follow-up on accounts will be pended during the appeal process.

Other Providers:

Nathan Littauer Hospital’s decision to provide Financial Assistance in no way affects the responsible party’s financial obligations to physicians or other health care providers not employed by the hospital.

Collection Policies:

  1. After Financial Assistance adjustments has been computed and applied, the remaining balances will be treated in accordance with Patient Financial Services policies regarding self pay balances.


Revised 3/06, 1/07, 4/07, 9/10, 7/13, 12/13, 1/15