King's Daughters' Health offers free or discounted services to help with out-of-pocket expenses for qualified individuals that have emergency and other medically necessary hospital-level care if:
- You are a permanent resident within the KDH primary service area, which includes the Indiana counties of Jefferson, Ripley and Switzerland and the Kentucky counties of Carroll and Trimble; and
- Your family income and size are at or below 300% of the Federal Poverty Guidelines (FPG); and
- Your services meet the definition of emergency and medically necessary as outlined in policy.
Under our facility's financial assistance policy (FAP), we provide financial assistance for emergency and other medically necessary care on a sliding scale discount from our normal charges if you are a resident within the KDH primary service area, and if your family income level qualifies based upon your income and family size.
All applicants will be screened for Medicaid coverage and must cooperate with hospital representatives to be eligible under our FAP. If you are eligible for financial assistance under our policy, you will receive free or other discounted assistance according to the following sliding scale:
|Annual family income||Amount of discount|
|Less than 200% FPG||100%|
|201 to 225% FPG||80%|
|226 to 250% FPG||60%|
|251 to 275%||40%|
|276 to 300%||20%|
Even if your family income exceeds 300 percent of the FPG, if you supply information to support exceptional medical circumstances (for example, terminal illness, excessive medical bills and/or medications, etc.) you may be considered on a case-by-case basis for assistance.
If your insurance does not provide coverage for your services—or if you have exhausted your lifetime maximum insurance benefits—and if you meet the income criteria, you may be eligible for assistance under our FAP.
If you receive an award of financial assistance under our FAP and your award does not cover 100 percent of our charges for the service, you will not be charged more for emergency or other medically necessary care than the amount we generally bill patients having insurance.
Financial aid policy and application forms
- Financial assistance program summary.
- Financial assistance application.
- Financial assistance application (PDF - printable)
- Financial assistance policy.
- Independent providers exclusion list.
In addition to downloading the forms above, you may also access our FAP and application form at the following locations:
- Emergency Department.
- Hospital Registration.
- Customer Service.
- King's Daughters' Hospital.
- KDH Business Operations Center.
In addition, if you provide your mailing address to a financial counselor or customer service representative, we will mail you a copy of our FAP and application form.
Customer Service: 812.801.0161
Request by mail by writing to:
King's Daughters' Health
P.O. Box 447
Madison, IN 47250
For information regarding your FAP and application form, please contact our financial counselors at any of our locations or by calling any telephone number listed above.
This program does not include coverage for independent provider groups not employed by the hospital, such as a cardiologist, emergency room physicians, nephrology, neurosurgery, pain clinic, and any other physician or advanced practice nurse that may be involved in your care.