Waverly Health Center

Financial Assistance Program

Money problems should never stop you from getting necessary medical care. Your job may offer a health plan, but it might not cover some of the care you need. Maybe unemployment has made it hard for you to make ends meet, and the bills are piling up. In spite of these problems, we may be able to help.

Medicaid Eligibility

We can help you apply for Medicaid. The application will be submitted to your county Department of Human Services.

Financial Assistance for Medical Care

Our financial assistance program helps those who are not able to pay for needed services. You may qualify for discounts on necessary medical care if you meet the criteria for financial assistance plus one or more of the following:

  • Do not have health insurance
  • Have health insurance, but it does not fully cover the medical care you need
  • Are not eligible for Medicaid

Patient eligibility for financial assistance is based on income and family size guidelines as determined by Federal Poverty Guidelines published by the Department of Health and Human Services. Some additional restrictions may apply.

How to Apply for Financial Assistance

You may ask about our financial assistance program during registration or through your nurse, social worker or the business office. You may also download the application below.

  • Our patient financial counselor will meet with you to determine your financial needs to see if you meet the eligibility requirements for any assistance programs.
  • You must complete the needed applications and show financial need by providing requested documents, such as proof of income.
  • Our patient financial counselor will complete the financial assistance review and let you know if aid is approved or denied.


Financial Assistance Frequently Asked Questions

Who can apply for help?

  • United States (U.S.) citizens
  • Non-U.S. citizens who are classified as legal immigrants, international students, temporary residents or legal visitors
  • Adults, their spouse and dependents
  • People who do not have insurance or those who cannot pay a balance left after their insurance pays

What care does this apply to?

  • All services needed for the safety and well-being of the patient received from WHC providers and billed by WHC.
  • Care that is not billed by WHC is not covered by this policy; such as, charges for reading and evaluating the results of radiology or pathology tests, fees for visiting specialists, Rohlf Clinic (UnityPoint) doctors or staff. Full List of Providers Services Not Covered by WHC Financial Assistance Program

Amounts charged to patients without insurance
WHC bills people who do not have insurance a discounted amount set each year based on claims paid by Medicare, Medicaid and private insurers over a 12 month period. This discount is applied automatically to the first bill.

Determining discounts

  • Uninsured people may be able to get more help based on their income as a percentage of the Federal Poverty Level (FPL).
  • If an application is approved, all bills for care received in the 12 months before the date of the application will be discounted.
  • Once a discount has been given, it will be valid for 12 months from the date of the application without the need to fill out a new one.
  • If income changes for someone who has been given a discount and a new rate is requested, a new application will be needed.

How to apply
Complete WHC’s “Application for Financial Assistance.” The form can be found in the following places:

  • On this webpage
  • By calling our Patient Financial Counselor at (319) 352-4928
  • Picked up at the green entrance of Waverly Health Center
  • Picked up in any of WHC’s clinics

What will be required?

  • A fully filled out application
  • A copy of the most recent filed Federal Income Tax return
  • If employment has changed since the tax return was filed, copies of the last 2 paystubs
  • If patient is unemployed, a copy of the last paystub and the unemployment award letter
  • A copy of any denial letter from county or state assistance programs (ex. Medicaid)
  • Other items may be acceptable or needed based on the situation

WHC has the right to deny financial assistance to any person who does not turn in a completed application or does not give proof of income needed to figure out the discount rate.

Patient Financial Counselor
Jennifer DeWitt (319) 352-4928

Becky David

Monday – Friday
8 a.m. to 4:30 p.m.
Other times by appointment

Contact Us
Email questions to FinancialAssist@WaverlyHealthCenter.org

Completed application with supporting documents can be faxed to (319) 483-4186