Consistent with its mission to provide comprehensive and compassionate care that improves the health of the people we serve, Dayton Children’s Hospital is committed to providing Financial Assistance to every person in need of emergency or other medically necessary treatment if that person is uninsured, underinsured, ineligible for other government programs, or unable to pay based on their individual financial situation.
Eligible Care.
Financial assistance is available under our Financial Assistance Policy (FAP) for emergency care or other medically necessary care provided by Dayton Children’s Hospital for Eligible Patients.
Patient Eligibility Requirements.
The Dayton Children’s Hospital Financial Assistance Program is available to uninsured patients and patients with self-pay balances after insurance that have met all financial criteria based on the disclosure of, and assessment of, proper information and documentation (Eligible Patients). FAP is a charity program based on the patient's family income. Patients with family incomes at or below 400% of the Federal Poverty Guidelines (FPG) are eligible for financial assistance along the following sliding scale:
INCOME RANGE DISCOUNT %
Income <= 100% FPG 100% Assistance
Income >100% and <=200%FPG 80% Assistance
Income >200% and <=300% FPG 60% Assistance
Income >300% and <=400% FPG 15% Assistance
COVID -19 Relief : Notwithstanding the above information, for clinical services rendered the period beginning April 2020 through June 2021, Dayton Children’s may qualify patients for additional COVID-19 financial relief discount on outstanding patient balances. To be eligible for this discount the patient/family must apply for financial assistance through the normal process as outlined in this policy. Completion of this application process will qualify the patient/family, at that point, for a discount on outstanding balances. This discount will be in effect at the discretion of Dayton Children’s Hospital for a time period related to the COVID-19 impact on the Dayton area community.
Patients with family income exceeding 400% of the Federal Poverty Guidelines may still be eligible for hardship financial assistance on an individual basis. The Patients' expenses and liabilities are considered in the evaluation of their eligibility for approval. Patients are expected to contribute payment for care based on their individual financial situations; therefore, each case will be reviewed separately. Financial Assistance is not considered an alternative option to payment, and patients may be assisted in finding other means of payment or financial assistance before approval for the Dayton Children’s Hospital Financial Assistance Program.
No Eligible Patient will be charged more for emergency or other medically necessary care than Amounts Generally Billed (AGB) for those patients who have insurance covering such care.
About the Application Process.
The process for applying for financial assistance under our FAP includes these steps:
- Fill out our FAP Application Form (also referred to as the FAA) and include the required supporting documents
- Completed applications can be returned the following ways: Mail to: Dayton Children's Hospital, Patient Family Financial Advocate, Department 1A, One Children's Plaza, Dayton, Ohio 45404-1815, fax to: 937-641-6101 Attn: Financial Advocate, email to: FinancialAdvocates@childrensdayton.org
- The Financial Assistance Department will review your completed application along with the documentation you provided to determine your eligibility.
- We will contact you if additional information is required to complete your application process and/or when a decision has been made. Please allow 30 days for us to complete the evaluation process.
Where to Obtain Information.
You may obtain a free copy of our FAP and FAP Application Form by visiting the links above or by contacting our Financial Assistance Department at 937-641-5727. Upon your request, our Financial Assistance Department will mail you a free copy our FAP, FAP Application Form, and Plain Language Summary to the address you provide. Free Copies of the FAP, FAP Application Form, and this Plain Language Summary are available in hard copy at Dayton Children’s Hospital, Patient Account Department, One Children’s Plaza, and Dayton, Ohio 45404.
Other services which are separately billed by other providers who are not employees of Dayton Children’s Hospital, such as independent physicians, are not eligible under our FAP.
Our FAP, FAP Application Form, and Plain Language Summary are available in English, Spanish, and Russian.
You can also read this policy in Arabic, Kinyarwanda, Spanish, Swahili and Russian.