Financial Assistance Application
Review our application and apply for financial assistance to manage your health care costs.
COVID-19 billing questions: For any billing questions related to COVID-19 screening, testing and treatment, please call customer service at 877-631-4262, Monday through Friday, 8 a.m. to 4 p.m.
Please note that all WellSpan Medical Group (employed) physicians and advanced practice clinicians participate in WellSpan's financial assistance programs.
Printed copies of our entire financial assistance policy and plain language summary (available in English and Spanish) are available to you at no cost, either by download below or by visiting or calling a WellSpan patient financial services office.
Review our application and apply for financial assistance to manage your health care costs.
Learn about our commitment to provide financial assistance to eligible patients in need.
Learn about our financial assistance policy with a summary that's easy to read and understand.
Discover how we approach patient billing and collections, helping ensure fairness and respect for all patients.
Learn about our self-pay patient credit policy.
Our decision to grant financial assistance will be based on a review of your (or your family’s) income and assets. You’ll need to apply for free or discounted care by completing the above financial assistance application.
The federal poverty guidelines, which are updated annually, are used to determine eligibility. You’ll be required to share proof of income — such as current pay stubs, Social Security, disability or other sources.
Additional information, such as copies of tax returns and/or bank statements, may be requested and could affect our decision.
If you need assistance with your application, you can complete it verbally by contacting one of our offices.
Before being granted financial assistance, you’ll need to prescreen for Pennsylvania’s Medical Assistance (Medicaid) program and show your rejection if denied. Failure to apply for or cooperate with Pennsylvania’s Medical Assistance (Medicaid) program will result in exemption from financial assistance.
If you’re found to be eligible for assistance, we offer discounts ranging from 20 percent to 100 percent for WellSpan-provided services.
We’re committed to charging no more than the average amount generally billed for a given service.
Your eligibility will be maintained for one year from the date of determination. Financial assistance may not be available if you live outside of WellSpan's primary service areas.
If you have questions, need more information or wish to submit your financial assistance application (including supporting documents), please contact the office nearest you.
WellSpan Gettysburg Hospital
147 Gettys St., P.O. Box 3786
Gettysburg, PA 17325-0786
717-851-5051, Monday through Friday, 8 a.m. to 4 p.m.
WellSpan Waynesboro Hospital
501 E. Main St.
Waynesboro, PA 17268
WellSpan Ephrata Community Hospital
Customer Service Department
169 Martin Ave., P.O. Box 1002
Ephrata, PA 17522-1002
WellSpan Good Samaritan Hospital
Patient Financial Advocate 1st FL/PAS
4th & Walnut Streets
Lebanon, PA 17042
WellSpan Good Samaritan Hospital/WellSpan Medical Group
4th & Walnut Streets
Lebanon, PA 17042
717-851-5051, Monday through Friday, 8 a.m. to 4 p.m
Patient Financial Services
601 Memory Lane
York, PA 17402
717-851-5051, Monday through Friday, 8 a.m. to 4 p.m.
Patient Financial Services
283 S. Butler Road, P.O. Box 550
Mt. Gretna, PA 17064
Check out these community resources that may be able to offer additional help.