Patient Assistance Program
Quality Care for All
To apply for the Sliding Fee Discount Program, please download the applications below. You can bring the application and your Proof of Income to your visit and our team will help determine if you qualify.
Patient Services
- Sliding Fee Scale
- Rx Assistance
- Medicaid & Medicare Assistance
- Health Insurance Marketplace
Delhi Hospital & Clinics offers discounts based on income in accordance with federal poverty guidelines and household size. You can qualify even if you are insured. Please note that the Sliding Scale Fee is not insurance, and qualifying for Sliding Scale Fee at DH&C only covers services accessed at DH&C.
If you have concerns about paying for your prescriptions, we have a Prescription Assistance Program that may be able to help. Please talk to your Delhi Provider about your concerns, and they will connect you with the program.
As a Certified Medicaid Application site, we can assist you with completing Medicaid applications for you and/or your children. These services are offered at no-charge to you.
For our patients with Medicare, we can assist you in enrolling or re-enrolling annual in your Medicare Part D plan. We will be glad to assist you with any other questions you may have regarding your Medicare policy
We have Certified Application Counselors on site who can provide you with assistance in completing applications, renewals, exemptions/appeals, or any other questions you may have regarding insurance.
How to Apply
• Prior year W-2
• Two recent pay stubs
• Letter from employer or Form 4506-T (If W-2 is not filed)
• Self-employed: Three months of income & expenses
• If you do not have any written proof of income, you can submit a self-declaration of income letter.
Contact Us
Today
Certified Application Counselor
Phone
(318) 878-6218
gbell@delhihospital.com
