Our Financial Assistance Application is located in the FORMS section of this webpage. Simply fill it out and return it to our billing office for processing.

If I don't qualify for financial assistance, what are my options?

Even if you don't qualify for financial assistance, you may set up payment plans at any time by calling our Customer Call Center. 937-384-4788

Do I qualify for assistance if I have insurance coverage?

Patients with insurance may qualify for assistance if their household is under the Federal Poverty Level.

What are the 2020 Federal Poverty Guidelines?

https://www.federalregister.gov/documents/2020/01/17/2020-00858/annual-update-of-the-hhs-poverty-guidelines

Will this financial assistance help with doctor bills?

No. The KHN Financial Assistance Program is for hospital charges only.

Covered facilities
Kettering Medical Center
Sycamore Hospital (includes KBMC)
Soin Hospital
Grandview Hospital
Southview Hospital
Fort Hamilton Hughes Hospital
Kettering Behavioral Medicine Center

For a list of NON-covered providers please click here.

Outpatient Scheduling Questions

This form is NOT for initial scheduling purposes.

Frequently Asked Questions

How do I apply for Financial Assistance?

If I don't qualify for financial assistance, what are my options?

Do I qualify for assistance if I have insurance coverage?

What are the 2020 Federal Poverty Guidelines?

Will this financial assistance help with doctor bills?

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