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.

By completing and signing our financial assistance application, you acknowledge that you made a good faith effort to provide all 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 is available on the U.S. Department of Health & Human Services website.


2019 Poverty Guidelines

Family / Household Poverty Guideline
  1   $12,490
  2   $16,910
  3   $21,330
  4   $25,750
  5   $30,170
  6   $34,590
  7   $39,010
  8   $43,430
  Families > 8   Add $4,420 For Each
  Additional Person
The poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The guideline listed above applies to the 48 contiguous states and the District of Columbia.


Financial assistance from Wayne HealthCare is secondary to 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 5947.

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

Wayne HealthCare
Financial Counseling
835 Sweitzer Street
Greenville, OH 45331