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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. Click here for our financial assistance policy.

Applications for Financial Assistance

Applications for financial assistance may be obtained in the following ways:

  • In person at the Cashier, Registration, or Patient Financial Services office.
  • 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.

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 ClaimAid 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.

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