Financial Arrangements


The hospital's basic daily rate includes 24 hour nursing care, nutrition services, housekeeping services, and linens. It does not include special services that your doctor may order such as operating room, anesthesia, physical therapy, X-ray, medications, laboratory, or other specific diagnostic and therapeutic services.

The professional service fees of your personal physician and other specialists and consultants you may see are not included in the daily rate. These fees are billed to you directly by the physician and are payable by you or your insurance company.

Our staff will file a claim with your insurance company at the earliest possible date following your discharge. Follow-up will begin 30 days after the submission of the claim. We will provide all necessary information to your insurance company to make a determination for payment. You will be expected to make full payment of the account balance if insurance fails to pay timely or denies payment, and of your self-pay portion (co-insurance and deductible) at time of discharge.

If you do not have insurance, you will be expected to make payment or payment arrangements through the Business Office prior to registration unless the treatment is an emergency. Otherwise, your registration may be postponed in cooperation with your physician.

At Daviess Community Hospital, a financial counselor is on staff to discuss confidential arrangements with you or a member of your family. We accept cash, check, or credit card including Mastercard, Visa, Discover, or American Express. We will assist you in applying for Medicaid and Charity Care.


 FINANCIAL ASSISTANCE PROGRAM

Daviess Community Hospital offers a Financial Assistance program for those eligible patients unable to pay.  An application will be given to any person who could reasonably be expected to act for the patient according to HIPAA criteria, has a reasonable basis to believe that the person may qualify for the uncompensated services, and can provide the information to establish eligibility.

 

 

HOW TO APPLY FOR FINANCIAL ASSISTANCE

 

  1. Obtain Financial Assistance application form from Patient Financial Services, Cashier, or Registration areas; by calling (812) 254-2760 extension 1013; or Click Here  for the Financial Assistance Form
  2. Return completed application with proof of income to the address listed below or in person at the Patient Financial Services, Cashier, or Registration area.

        Daviess Community Hospital, PO Box 32, Washington, IN 47501

Assistance in completing the application is available by contacting Patient Financial Services department (812) 254-2760.  Patients will be contacted by letter with the approval decision after the Financial Assistance application has been processed.

DETERMINING ELIGIBILITY


  • Patient must reside in Daviess, Martin or Pike counties.
  • Patient must have limited or no income.
  • Patients are expected to apply for state/federal medical assistance before applying for charity care.  A ClaimAide representative is available in the hospital to assist with that application.
  • Patient was denied state/federal medical assistance or approved for medical assistance but did not have the assistance backdated.
  • US Citizen
  • Patients who would have been eligible for 3rd party coverage and failed to comply with the terms of that payer will not be eligible for financial assistance.

 

 

NOTIFICATION OF APPLICATION STATUS

 

Patients will be notified by letter of the financial assistance application determination.