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
365体育投注 Health
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

365体育投注 Warsaw
1355 Mariners Drive
Warsaw, IN 46582

Additional Resources

Federal Poverty Guidelines

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]

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