Financial Assistance Program
Assistance for Medical Expenses in Washington, Indiana
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
APPLICATIONS FOR FINANCIAL ASSISTANCE
Applications for financial assistance may be obtained in the following ways:
- In person at Cashiers, Registration, or Patient Financial Services
- Over the phone by calling (812) 254-2760
Click here to download the form.
PROCESSING APPLICATIONS FOR FINANCIAL ASSISTANCE
The patient or the patient representative should complete the financial
assistance application as soon as possible after services are rendered.
The application must include all requested information i.e. proof of income.
Assistance for completing the application is available in Patient Financial Services.
- 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
Patients will be notified by letter of the financial assistance application