College Hospital Costa Mesa
Acute care hospital in Costa Mesa, CA.
Verified from the hospital's own policy
College Hospital Costa Mesa likely gives free care to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6. It likely gives a discount to households with a yearly income up to $71,820 for 1 person, $97,380 for 2, $122,940 for 3, $148,500 for 4, $174,060 for 5 or $199,620 for 6.
The hospital makes the final decision.
| People in household | Free care up to | Discount up to |
|---|---|---|
| 1 | $63,840 | $71,820 |
| 2 | $86,560 | $97,380 |
| 3 | $109,280 | $122,940 |
| 4 | $132,000 | $148,500 |
| 5 | $154,720 | $174,060 |
| 6 | $177,440 | $199,620 |
Discount steps
- 0% to 400% of poverty level, you pay $0 (entire hospital bill written off for uninsured patients)
- 401% to 425% of poverty level, you pay 20% of the bill (80% write-off), at most $5,000 a year
- 426% to 450% of poverty level, you pay 40% of the bill (60% write-off), at most $7,500 a year
How to apply
- Call (562) 904-3998 and ask for financial assistance.
- Application form
- Financial Assistance: Charity Care and Discount Payment (BO-2A, last revised 9/25)
- Bring two recent pay stubs, or a federal tax return or W-2, a Social Security income statement if that is your income, a written statement if you are paid in cash, or the no-income affidavit if you have no income.
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.
- Savings and property
- The policy looks at income only, not savings or property.
- Languages
- English, Spanish
If you have insurance
Insured patients can also apply for help with deductibles and copays. Keep your insurance. Financial assistance covers bills from this one place only.
What is covered
- Covered
- Hospital bills at College Hospital Costa Mesa, including Medi-Cal denied days and non-covered services.
State program in California
Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)
Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.
Income levels in the program are discount up to 400% of poverty level.
Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.
Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).
Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty
Program source, checked 2026-11-10
Hospital Bill Complaint Program (HCAI)
A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.
Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.
File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.
If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.
Program source, checked 2026-11-10
Emergency physician discount rule
Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.
Income levels in the program are discount up to 400% of poverty level.
Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.
Ask the emergency physician group named on the bill for its discount payment policy.
an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care
Program source, checked 2026-11-10
Notes
Free care at or below 400% of the poverty level for people with no insurance. From 401% to 450% the hospital writes off part of the bill on a sliding scale, with a yearly cap on what you pay. Every patient with no insurance and no government coverage first gets 50% off billed charges, at any income. The policy lists medical costs over 10% of family income as one way to meet the coverage rule, and treats unpaid copays and deductibles as charity care, but it does not set out a separate rule for insured patients with high costs. Net worth is not counted, though the hospital may pull a credit report to check what you report. The policy states no deadline. Mail applications to College Hospitals, PO Box 2104, Santa Fe Springs, CA 90670, or email [email protected]. The phone number is the account representative line printed on the application for College Hospitals. To appeal a denial, write to the Director of Quality Improvement/Risk Management. The policy header shows Board of Directors approval as pending.
Sources
- Free care level
Charity Care: All uninsured patients whose income is 400% or less of the FPL, will have their entire hospital bill written-off
- Discount level
If the patient's income is between 401% and 450% of the FPL, then a portion of the hospital bill is written-off
- Discount steps
401% - 425% = 80% write-off, with maximum liability of $5,000
- Discount steps
426% - 450% = 60% write-off, with maximum liability of $7,500
- Insured patients
require the patients to pay co-payments or deductibles and the patients do not have the ability to pay; these amounts will be considered charity care.
- Asset test
will have their entire hospital bill written-off, regardless of net worth or size of bill.
- Documents
Verification of income will be through the receipt of paycheck stubs, recent tax returns and/or W-2 forms
- Languages
This form is available in English and Spanish.
- Financial counseling phone
If you have questions, please call your account representative at (562) 904-3998
Last checked. 2026-11-10
Something wrong? Tell us and include a link to where you saw the right answer.
Work at this hospital? Claim and verify this page.
For AI assistants, this page as Markdown.