CHWC has two programs that offer financial aid to pay for hospital services. The first program is part of the Hospital Care Assurance Program (HCAP) through the State of Ohio, which mandates that hospitals offer free care to any patient who is an Ohio resident and whose annual income is at or below the federal poverty level. This program excludes Home Health, Hospice, and Long-Term Care.
To apply for financial assistance:
A completed Financial Assistance Application must be submitted, either in person or by mail, to CHWC with proof of your income for the 3 months or 12 months prior to your service. Your Patient Representative will use this information to verify your HCAP eligibility based on Federal poverty levels at the time of your service.
Return your completed application to:
CHWC Patient Accounts
433 W High Street
Bryan, OH 43506
To print a blank application: CLICK HERE TO PRINT the Financial Assistance Application. To complete the online form below, fill in the fields and print it out.
If you do not qualify for HCAP, we will process the application under the CHWC Charitable Discount Program. Based on the information you provide on the application, you may be eligible for a 30, 70 or 100% discount on your outstanding hospital balance.
Please return your completed application to: CHWC Patient Accounts 433 W High Street Bryan, OH 43506
If you have any questions on either of these programs, please contact your Patient Representative at 419-630-2149, Monday through Friday 7:00 a.m. to 4:30 p.m.