Financial Assistance Policy

Understanding Your Cost for Care

At Community, we are committed to high-quality care that puts patients first. To help deliver an exceptional patient experience, we offer price estimates for your healthcare. The Pricing Support Center's cost estimate service helps patients understand their potential out-of-pocket costs for care at Community.

Financial Assistance Program (Summary)

Summary - English (PDF) Summary - En Español (PDF)

Community Health Network serves the medical needs of the community, regardless of race, creed, color, sex, national origin, sexual orientation, handicap, age, ability to pay, or any other classification or characteristic.

We recognize the need to provide care to the sick that do not have the ability to pay. Patients who meet the requirements of our Financial Assistance Program can receive medically necessary healthcare services at a significantly reduced cost based on verified financial need. Community understands and honors the need to maintain the dignity of the patient and family during the application process.

Patients who identify themselves as unable to pay all or a part of their medical care have the right to request financial assistance. An application process is consistently followed to determine if patients meet the requirements of the Financial Assistance Program, or if they may qualify for other forms of assistance. Financial assistance is not considered a substitute for personal responsibility. Patients are expected to cooperate with Community’s procedures and fulfill the documentation requirements needed to qualify for the assistance program. In addition, patients are expected to contribute to the cost of their care based on their ability to pay. Individuals who have the financial ability are encouraged to purchase insurance to ensure access to future healthcare services, protect their overall health and protect their assets.

Do I Qualify?

Although other factors, such as bankruptcy, catastrophic healthcare expenses, household assets, etc., are sometimes considered, the primary qualification for financial assistance is household size and household income compared to the annually adjusted federal poverty line. A household consists of head of household, spouse and all “dependents” as defined by federal IRS guidelines. The following table shows the financial assistance level that patients may qualify for under Community’s Financial Assistance Program.

Individuals eligible for financial assistance will not be charged more for emergency or other medically necessary services than the amounts generally billed to individuals who have insurance covering such services.

Community Health Network Financial Assistance Table 2020

The following table shows the financial assistance level that patients may qualify for under Community’s financial assistance program.

 % of Federal Poverty Line  ≤200%  201-225%  226-250%  251-275%  276-300%  >300%
 Financial Assistance Level  100%  90%  80%  70%  60%  0%
 Federal Poverty

Monthly Household Income Range

1 $1,063 ≤ 2,127 2,128-2,393 2,394-2,658 2,659-2,924 2,925-3,190 ≥ 3,191
2 $1,437 ≤ 2,873 2,874-3,233 3,234-3,592 3,593-3,951 3,952-4,310 ≥ 4,311
3 $1,810 ≤ 3,620 3,621-4,073 4,074-4,525 4,526-4,978 4,979-5,430 ≥ 5,431
4 $2,183 ≤ 4,367 4,368-4,913 4,914-5,458 5,459-6,004 6,005-6,550 ≥ 6,551
5 $2,557 ≤ 5,113 5,114-5,753 5,754-6,392 6,393-7,031 7,032-7,670 ≥ 7,671
6 $2,930 ≤ 5,860 5,861-6,593 6,594-7,325 7,326-8,058 8,059-8,790 ≥ 8,791
7 $3,303 ≤ 6,607 6,608-7,433 7,434-8,258 8,259-9,084 9,085-9,910 ≥ 9,911
8 $3,677 ≤ 7,353 7,354-8,273 8,274-9,192 9,193-10,111 10,112-11,030 ≥ 11,031
Each Additional $373 ≤ 747 748-840 841-933 934-1,027 1,028-1,120 ≥ 1,121

Household income is calculated on a gross income basis before taxes, deductions and withholding and includes all sources of income such as wages, salaries, tips, pension, social security, rent, royalties, disability, alimony, child support, unemployment, etc. Income for all members of the household must be included in your calculation. It is important that you accurately estimate your income. Before granting Financial Assistance we will verify your household size and income through external data bases, tax returns, bank statements, vouchers, pay stubs and other relevant documentation as required.

This table is updated annually in accordance with the most recently published Federal Poverty Line.

Financial Assistance Program Policy

Policy - English (PDF)   Policy - En Español (PDF)

Financial Assistance Application

To apply for financial assistance, please download and return an application. Or you can pick up an application at any of our Community Health Network facilities.

Application - English (PDF)   Application - En Español (PDF)

Collections Policy

Please refer to Community's policy on collection of accounts and resolution (PDF).

What can I do if I have questions?

Financial assistance locations have reduced staff at this time. If you have additional questions or want to apply for financial assistance please contact a patient financial service professional or financial counselor by phone or email:

Community Health Network, Community Howard Regional Health, Community Howard Specialty Hospital
Phone: 317-355-5555 or toll-free 866-721-4205

Community Hospital Anderson
Phone: 765-298-3300 or toll-free 866-298-3300

Community Surgery Centers and Stones Crossing
Phone: 317-621-0300 or toll-free 855-621-0300

Return Forms

You may return documents by fax, email or US mail to:

Community Health Network, Community Howard Regional Health, Community Howard Specialty Hospital
Fax: 317-355-8778
Mailing Address: 6435 Castleway West Drive, Suite 200, Indianapolis, IN 46250

Community Hospital Anderson
Fax: 765-298-5801
Mailing Address: 1515 N Madison Avenue, Anderson, IN 46011
Drop Off: Emergency Department Entrance, 1515 N Madison Avenue, Anderson, IN 46011

Community Surgery Centers and Stones Crossing
Fax: 317-806-1621
Mailing Address: 10194 Crosspoint Blvd, Suite 400, Indianapolis, IN 46256