Financial Assistance Resources
365体育投注 Health is a not-for-profit, community-owned organization, providing financial assistance to individuals with limited or no ability to pay for services and who meet assistance guidelines.
Plain Language Summary
The Plain Language Summary helps explain 365体育投注 Health’s Financial Assistance Policy. It summarizes eligibility requirements for assistance and provides contact information so that you can obtain further information regarding the Policy or applying for financial assistance. This plain language summary is available in Spanish and Burmese below.
Plain Language Summary - English
Plain Language Summary - Spanish
Plain Language Summary - Burmese
Do I qualify?
Patients whose family income does not exceed twice the Federal Poverty Guidelines may be eligible for financial assistance. Certain family assets are considered in making the determination for eligibility under the Financial Assistance Policy. Patients must complete a Financial Assistance Application in order to be considered under 365体育投注’s Financial Assistance program. Patients must apply for Financial Assistance within 240 days of the date a patient is sent the first statement due for that date of service.
How do I obtain more information?
The Financial Assistance Policy and the Financial Assistance Application (both below) provide more detailed information regarding eligibility and the application process. You may download the forms here:
[Financial Assistance Policy]
Financial Assistance Policy - Spanish
Financial Assistance Policy - Burmese
[Financial Assistance Application]
Financial Assistance Application - Spanish
Financial Assistance Application - Burmese
You may also send a written request to:
Attention: ARS Team Patient Financial Services
P.O. Box 5600
Fort Wayne, IN 46895
The Financial Assistance Policy and the Financial Assistance Application are also available by calling the Patient Financial Services Call Center at 260-266-6700 or toll free 855-814-0012, or by visiting any cashier office between the hours of 9 am and 4 pm at the following locations:
365体育投注 Regional Medical Center and 365体育投注 Ortho Hospital
11109 365体育投注 Plaza Drive (Entrance 1)
Fort Wayne, IN 46845
365体育投注 Hospital Randallia
2200 Randallia Drive
Fort Wayne, IN 46805
365体育投注 DeKalb Hospital
1316 E. 7th Street
Auburn, IN 46706
365体育投注 Huntington Hospital
2001 Stults Road
Huntington, IN 46750
365体育投注 LaGrange Hospital
207 N. Townline Road
LaGrange, IN 46761
365体育投注 Noble Hospital
401 Sawyer Road
Kendallville, IN 46755
365体育投注 Wabash Hospital
10 John Kissinger Drive
Wabash, IN 46992
365体育投注 Whitley Hospital
1260 E. State Road 205
Columbia City, IN 46725
1355 Mariners Drive
Warsaw, IN 46582
Federal Poverty Guidelines
Charges from certain physicians on 365体育投注 Health facilities’ medical staff are eligible for consideration under 365体育投注’s financial assistance policy. Please see this document for information regarding physicians as of 10/1/2020.
365体育投注 Health’s Collections policy may be downloaded below.
Collections Policy - Spanish
Collections Policy - Burmese
Information for Average Generally Billed at 365体育投注 Health facilities may be downloaded below.
Average Generally Billed