Financial Assistance for 2012-2016 Services

Cottage Health’s mission is to provide superior health care for and improve the health of our communities through a commitment to our core values of excellence, integrity and compassion.

For many years, Cottage Health has offered a financial assistance program to patients unable to pay for emergency or medically necessary care. Cottage Health further expanded this program in September 2017. Program eligibility requirements are included within the financial assistance policy.

If you have been a patient or the guarantor of a patient at a Cottage Health facility in the past but did not previously complete a financial assistance application, you are invited to contact us to see if you meet eligibility criteria for your previous visits.

Eligibility is based upon family income level and requires the completion of a financial assistance application and submission of supporting documentation such as tax returns. To request more information regarding a retrospective review of eligibility, you may contact the Cottage Health Business Office at (866) 459-6003, by email at


Eligibility is based upon family income in comparison to the federal poverty level. Patients are eligible for financial assistance if their family income does not exceed 350 percent of the federal poverty level for the year in which the date of service occurred. Patients whose family income is higher than 350 percent of the federal poverty level may be eligible for a discount.

Please refer to the federal poverty level discount tables to consider your potential discount based upon your family income at the time you received your care. Use the federal poverty level table for the year in which your date of service occurred.

If you have multiple dates of service spanning across multiple years, a separate review of your income will be performed for each separate year, but only one application is required. You will, however, be asked to provide tax records for each separate year.

When a completed financial assistance application is received, the application will be reviewed and a final determination letter will be mailed.

If additional documentation is needed, the patient/guarantor will be notified. For dates of service in 2017 or 2018, please refer to this link to view the federal poverty level tables as well as the application for dates of service 1/1/2017 through present.

2012-2016 Financial Assistance Applications

To apply for financial assistance, please complete the application in your preferred language. The Cottage Health Business Office is available to assist with the completion of Financial Assistance Applications Monday through Friday between the hours of 8 a.m. - 4 p.m. You may also call to schedule an appointment at 805-879-8963.


Español (Spanish)

Tagalog (Tagalog)

漢語 (Mandarin)

Other Ways to Request Documents

To request a copy of Cottage Health’s Financial Assistance Application, Policy, Plain Language Summary or Amounts Generally Billed summary, please call, email, mail or visit us:

Phone: Cottage Health Business Office, (805) 695-2518 (Phone hours: 5am–5pm PST,  Monday–Friday)


Mail: Cottage Health, Attention: Financial Assistance Program, P.O. Box 689, Santa Barbara, CA 93102

Online: Follow this link to download and print the Cottage Health Financial Assistance Application

In Person: Any of our Cottage Health Emergency Departments, or the Business Office:

  • Santa Barbara Cottage Hospital | 400 W. Pueblo Street, Santa Barbara, CA 93105 | (805) 682-7111 extension 53692
  • Goleta Valley Cottage Hospital | 351 S. Patterson Avenue, Santa Barbara, CA 93111 | (805) 967-3411 extension 66484
  • Santa Ynez Valley Cottage Hospital | 2050 Viborg Road, Solvang, CA 93463 | (805) 688-6431 extension 74800
  • Cottage Health Business Office | 6550 Hollister Avenue, Goleta, CA, 93117 | Office hours: 8 a.m. - 4 p.m., Monday - Friday.