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Financial Assistance

Patients may be eligible to receive free or discounted care. To see if you are eligible, download and complete the Financial Assistance Program Application. You can also obtain an application in person, by mail or fax by contacting a Financial Counselor at (937) 547-5770. For more information about Financial Assistance at Wayne HealthCare Download the Billing & Financial Counseling Booklet.

By completing and signing our financial assistance application, you acknowledge that you made a good faith effort to provide all the information requested in the application to assist Wayne HealthCare in determining your eligibility for financial assistance. Assistance is based on the Federal Poverty Guidelines, which is adjusted for family size and location. More information on the Federal Poverty Guidelines are updated each year and are available on the U.S. Department of Health & Human Services website.

Financial assistance from Wayne HealthCare is secondary to the financial resources available to the patient. Resources may include but aren't limited to: insurance, third-party liability, government benefits, support from community agencies, and/or personal resources.

For more information, you can contact a financial counselor at (937) 547-5770 or (800) 859-2963 extension 6947.

Return your completed Financial Assistance Application form, along with supporting documents to:

Wayne HealthCare
Financial Counseling
835 Sweitzer Street
Greenville, OH 45331