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Financial Assistance

Financial Assistance Program

At Griffin Hospital, we provide care without regard to source of payment. If you do not have insurance or another way to pay, please call our Financial Assistance counselors at (203)-732-1510. Fully staffed with bilingual employees, these caring professionals can help you see if you qualify for:

  • Free care
  • A fee reduction based on the hospital's Financial Assistance Program

Griffin Hospital Financial Assistance Policy — Plain Language Summary

Griffin Hospital’s Financial Assistance Policy (FAP) provides Eligible Patients (as defined below) with partially or full discounted emergency or other medically necessary health care services provided by the Hospital. Patients seeking Financial Assistance must apply for the program, as described below.

Definitions

Emergency or other medically necessary health care services provided by the HOSPITAL and billed by the HOSPITAL. Patients who need emergency services can receive care and qualify for a discount if they meet certain income levels. The FAP only applies to services billed by the Hospital. Other services that are separately billed by other providers, such as non-employed physicians or outside laboratories, are not eligible under the FAP.

Patients receiving Eligible Services, who submit a complete Financial Assistance Application (including related documentation/information), and who are determined eligible for Financial Assistance by the Hospital.


How to Apply

The FAP and the related application form may be obtained at no cost as follows:

  • In person at the Hospital’s main registration area, emergency room registration area, outpatient department, Via telephone, request an application be mailed to you by calling the Financial Assistance Department at 203-732-1510
  • By mail, send a request to Griffin Hospital 130 Division Street P.O. Box 337 Derby, CT 06418
  • Download the documents from the Hospital’s website below. There is no charge to download these materials, and patients are not required to create an account or provide personally identifiable information.
  • Mail or deliver completed applications (with all documentation/information specified in the application instructions) to: Griffin Hospital 130 Division Street P.O. Box 337 Derby, CT 06418

Generally, eligible patients are eligible for financial assistance, using a sliding scale, when their family income is at or below 250% of the federal government’s Federal Poverty Guidelines (FPG). Eligibility for Financial Assistance means that eligible persons will have their eligible services covered fully or partially, and they will not be billed more than "Amounts Generally Billed" (AGB) to Medicare. Financial Assistance levels, based solely on family income and FPG, are:

  • Family Income of up to 250% of FPG: 100% of Free Care
  • Family Income at 251% to 400% of FPG: Partial Financial Assistance

Not all physicians practicing at Griffin Hospital participate in the Hospital’s Financial Assistance Program. The following is a list of physician provider groups which follow Griffin Hospital’s FAP when the care provided is in the course of providing Emergency Medical Care or other Medically Necessary services at the Hospital:

  • Connecticut Emergency Medicine Specialists
  • Griffin Faculty Physicians

Note: Other criteria beyond FPG are also considered (i.e., availability of cash or other assets that may be converted to cash, and excess monthly net income relative to monthly household expenditures), which may result in exceptions to the preceding. If no family income is reported, information will be required as to how daily needs are met. The Financial Assistance Department reviews submitted applications that are complete, and determines financial assistance eligibility in accordance with the HOSPITAL’s Financial Assistance Policy. Incomplete applications are not considered, but applicants are notified and given an opportunity to furnish the missing documentation/information.

This Plain Language Summary, the FAP, and the FAP application form are available upon request from the Griffin Hospital, 130 Division Street Derby CT, 06418 and on our website.


Further Information/Help

For help, assistance or questions regarding the FAP, please visit or call the Financial Assistance Department. at (203) 732-1510, Monday through Friday from 8:30 am-5 p.m.

Below are links for the following documents:

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