Financial Assistance Policy Summary
Financial Assistance for Emergency or other Medically Necessary Care at Wayne Memorial Hospital
If you are unable to pay your bill, please contact the Business Office at the telephone number or address listed below to see if you are eligible for financial assistance. Each patient’s need for financial assistance is evaluated according to the level of his/her household income, in light of relevant facts and circumstances, such as reported income, assets, liabilities, expenses, and other available resources. Free care is available to patients whose household income is 200% or below the federal poverty level. For the 2018 federal poverty guidelines, click here Financial Asst – 2018 Poverty Income Guidelines
You may also visit http://aspe.hhs.gov/poverty/index.cfm, U.S. Department of Health and Human Services.
To apply for financial assistance, please download and fill out this application and return it to our Business Office:
Our complete financial assistance policy (“FAP”), along with an application for financial assistance, can be found at Financial Asst – Policy. Paper copies are also available at any patient registration area or the Business Office and will be mailed free-of-charge to a patient upon request:
Requests by phone: 570-251-6580
Requests by mail: Wayne Memorial Hospital
Attn: Patient Account Manager
601 Park Street
Honesdale, PA 18431
Individuals may apply for financial assistance under the facility’s FAP by mailing a completed application, along with proof of household income, to the above address or by bringing the application and proof of household income to any patient registration area or the Business Office. Patients may also call or visit the above location to receive assistance with the application process.
In the case of emergency or other medically necessary care covered under the FAP, patients eligible under the hospital facility’s FAP may not be charged more than the amounts generally billed (AGB) to individuals who have insurance covering such care.