Honesty implies and requires full and complete disclosure of required information and/or documentation. All uninsured patients and those who request financial assistance will be required to complete a Financial Assistance Application.

Prior to leaving LVMC, patients should verify what additional information or documentation must be submitted by the patient to LVMC. The patient shares responsibility for understanding and complying with the document filing deadlines of LVMC or other financial assistance programs.

Patients should expect and are required to pay any or all amounts due at the time of service. Said amounts due may include, but are not limited to:

  • Co-Payments
  • Deductibles
  • Deposits
  • Medi-Cal/Medicaid Share of Cost Amounts


The patient also shares a responsibility to assure that arrangements for settling the patient account have been completed. It is essential that each patient or their family representative cooperates and communicates with LVMC personnel during and after services are rendered.

The information you are presenting is an application and other financial disclosure information and not a guarantee of approval.  The information presented will be reviewed and analyzed timely against the Federal Poverty Criteria.

Please allow four or six weeks for review of your charity care assistance application and supporting documents before a ruling will be made on your application. 

If you have any questions please call, (805) 737-3300 ext 4326.