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Patient Price
Information List
In compliance with state law, Morrow County Hospital is
providing this price list containing our charges for room and
board, emergency department, operating room, delivery, physical
therapy and other procedures. The hospital's charges are the
same for all patients, but a patient's responsibility may vary,
depending on payment plans negotiated with individual health
insurers. Uninsured or underinsured patients should consult with
our admitting and billing staff to determine whether they
qualify for discounts. These prices are correct as of February 12, 2013.
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Room &
Board -- Per Day Charges |
| |
Charge |
| Medical/Surgical |
710.50 |
| PCU |
1,303.95 |
| Intensive Care |
1,753.00 |
| Swing Bed |
354.00 |
|
Morrow
County Hospital currently does
not offer these services |
|
Emergency
Department Charges |
Emergency Department charges are based on the level
of emergency care provided to our patients. The
levels, with level 1 representing basic emergency
care, reflect the type of accommodations needed, the
personnel resources, the intensity of care and the
amount of time needed to provide treatment. The
following charges do not include fees for drugs,
supplies or additional ancillary procedures that may
be required for a particular emergency treatment.
They also do not include fees for Emergency
Department physicians, who will bill separately for
their services.
| |
Charge |
| Level 1 |
158.50 |
| Level 2 |
223.95 |
| Level 3 |
374.30 |
| Level 4 |
566.10 |
| Level 5 |
811.80 |
Operating Room charges are based on the complexity level, with minor being the most basic, for a
particular operation. The following charges do not
include fees for drugs, supplies or additional
ancillary procedures that may be required.
| |
Charge |
| Gastroscopy (EGD) |
1,800.00 |
| Flex Bronc |
1,800.00 |
| Colonoscopy |
1,800.00 |
| EGD & Colonoscopy |
3,000.00 |
| Surgery Charge Minor 1 hr |
2,515.40 |
| Surgery Charge Minor 1 1/2 hr |
3,766.15 |
| Surgery Charge Minor 2 hr |
3,869.80 |
| Surgery Charge Minor 2 1/2 hr |
4,662.90 |
| Surgery Charge Minor 3 hr |
5,003.95 |
| Surgery Charge Minor 3 1/2 hr |
5,542.50 |
| Surgery Charge Minor 4 hr |
7,718.10 |
| Surgery Charge Major 1 hr |
3,958.20 |
| Surgery Charge Major 1 1/2 hr |
5,351.20 |
| Surgery Charge Major 2 hr |
6,611.55 |
| Surgery Charge Major 2 1/2 hr |
7,217.10 |
| Surgery Charge Major 3 hr |
9,121.40 |
| Surgery Charge Major 3 1/2 hr |
9,650.25 |
| Surgery Charge Major 4 hr |
10,887.25 |
| Surgery Charge Major 4 1/2 hr |
11,021.30 |
| Surgery Charge Major 5 hr |
12,082.60 |
| Surgery Charge Major 5 1/2 hr |
13,276.90 |
| Surgery Charge Major 6 hr |
16,645.15 |
The
following charges reflect the most common services
offered by our Physical Therapy department. Patients may
have additional charges, depending on the services
performed.
| |
Charge |
| Exercise each 15 minutes |
100.70 |
| Elec Stim Unattended |
65.15 |
| Manual Therapy |
99.30 |
| Elec Stim-MC |
65.15 |
| Initial PT Consult/Eval |
125.3 |
| Ultrasound each 15 min |
83.10 |
| Gait each 15 min |
53.90 |
| Therapeutic Proc/Group |
50.35 |
| Massage |
56.65 |
| Func/Kinetic Act Each 15 min |
75.80 |
| Neuro Muscle Reeducation |
61.40 |
| Iontophoresis each 15 min |
56.50 |
| Traction, Mechanical |
41.65 |
| Paraffin |
41.45 |
| Patient Re-Evaluation |
81.70 |
| ADL each 15 min |
63.50 |
|
Occupational Therapy Charges |
The
following charges reflect the most common services
offered by our Occupational Therapy department. Patients
may have additional charges, depending on the services
performed.
| |
Charge |
| Exercise each 15 minutes |
100.70 |
| Manual Therapy |
99.30 |
| Kinetic Activities |
75.80 |
| Massage 15 min |
56.65 |
| Func Capacity Eval Each |
57.55 |
| Paraffin |
41.45 |
| Initial OT Consult |
127.05 |
| ADL Training each 15 min |
63.50 |
| Neuromuscular re-ed |
61.40 |
| Elec Stim Unattended |
65.15 |
| COGN Perceptual Mtr Trm |
53.90 |
| Ultrasound each 15 min |
83.10 |
| Transfer Training Each 15 min |
63.50 |
| Therapeutic Proc\Group |
50.35 |
| Orthotic Training Each 15 min |
82.95 |
|
Pulmonary
Therapy Charges |
The
following charges reflect the most common services
offered by our Pulmonary Therapy department. Patients
may have additional charges, depending on the services
performed.
| |
Charge |
| Pulm Rehab Session |
65.90 |
| Pulm Rehab Evaluation |
115.95 |
| Pulm Rehab 6 min walk |
77.30 |
|
X-Ray &
Radiological Charges |
The
following charges reflect the hospital's 30 most
common x-ray and radiological procedures.
| |
Charge |
| Chest 2 View PA & Lateral |
257.60 |
| Mammo Cad Screeening |
33.20 |
| Mammo Screening Digital |
178.10 |
| Chest PA Only |
200.50 |
| CT Head w/o Contrast |
1,241.95 |
| CT Abd & Pelvis w/o Contrast |
1,862.95 |
| Foot Min 3 Views |
240.45 |
| L Spine Min 2 Views |
314.30 |
| Shoulder 2 Views |
240.15 |
| Knee 3 Views |
248.50 |
| Ankle Min 3 Views |
252.80 |
| CT Abd & Pelvis with Contrast |
2,138.90 |
| Hand 3 Views |
257.60 |
| C Spine 5 Views |
396.40 |
| CT Thorax with Contrast |
1,817.30 |
| DXA Bone Density Scan |
443.95 |
| Wrist 3 or More Views |
257.60 |
| Hip Complete Min 2 View |
233.15 |
| Spine/Cervical w/o Contrast |
1,436.00 |
| US Venous Unilateral |
644.00 |
| US Single Organ |
584.65 |
| Cartoid Art Sonogram |
573.25 |
| KUB w/up PA Chest |
501.70 |
| Elbow 3 Views |
257.60 |
| Abdomen/Kub |
232.45 |
| Ribs Unilateral |
266.50 |
| T Spine AP & Lat |
289.60 |
| Finger 2 Views |
186.10 |
| Mammo Cad Diagnostic |
33.20 |
| US Retroperitoneum Limited |
314.20 |
| CT Thorax W/O Contrast |
1,611.80 |
| US Pelvis |
417.65 |
The
following charges reflect the hospital's 30 most
common laboratory procedures.
| |
Charge |
| Venipuncture |
15.00 |
| CBC w Differential, Auto |
82.70 |
| Comp Metabolic Panel |
190.80 |
| Prothromin Time |
51.20 |
| Basic Metabolic Pnl |
116.60 |
| CPK |
47.70 |
| Troponin I |
128.15 |
| CKMB |
118.35 |
| Lipid Panel |
165.55 |
| TSH-Thyroid Stim Hormone |
114.24 |
| Urinalysis |
42.40 |
| Creatinine Blood |
42.40 |
| Bun-Blood |
44.50 |
| PTT |
51.85 |
| Culture Urine |
68.90 |
| Hemoglobin A1C |
74.20 |
| Electrolyte Panel |
68.40 |
| Culture Blood |
116.60 |
| Natriuretic Peptide-BNP |
129.48 |
| SGPT (ALT) |
69.10 |
| SGOT (AST) |
67.25 |
| Amylase |
84.30 |
| Lipase |
89.70 |
| Glucose |
31.98 |
| Urinalysis w/Micro |
42.90 |
| Drug Test, Single Drug Class |
223.84 |
| Potassium Blood |
26.68 |
| Magnesium |
46.71 |
| HCG-Urine Qual |
64.10 |
| HGB |
30.80 |
| Hepatic Function Panel |
144.15 |
STATEMENT OF
PURPOSE:
The mission of Morrow County Hospital is to improve the health of those we serve. We recognize this mission includes an obligation to provide access to health care services for all persons, regardless of their ability to pay. This policy establishes Morrow County Hospital's guidelines for free or discounted services based on specific income criteria as defined by the Federal Poverty Guidelines.
POLICY:
Morrow County Hospital provides free or reduced cost care in various forms including the Hospital Care Assurance Program (HCAP) and Charity Care programs. The HCAP program is the Ohio Department of Job and Family Services' (ODJFS) mechanism for meeting the federal requirement to provide additional payments to hospitals that provide a disproportionate share of uncompensated services to the indigent and uninsured. Morrow County Hospital provides additional assistance through its Charity Program based on income guidelines.
Eligibility Requirements
HCAP:
- Residency Requirement – The patient must be voluntarily living in the state of Ohio.
- Service Date
- Outpatient Services. Eligibility determination is effective for 90 days from the initial service date, during
which time a new eligibility determination need not be completed. Effective date for outpatient eligibility is
to be documented on each account, under system notes.
- Inpatient Services. Eligibility determination will be performed separately for each admission, unless the
patient is readmitted within 45 days of discharge for the same underlying condition.
- Services must be a medically covered service per ODJFS guidelines.
- Patient must meet the income guidelines of at or below 100% of the current Federal Poverty Income Guidelines
at the time of service.
- Family Size – Based on all dependents living in the household
- Patient cannot be a recipient of Medicaid or any other state Medicaid program.
HOSPITAL
CHARITY:
- Residency Requirement - At the time of treatment, the patient must be a resident of Morrow County or one of the surrounding counties of Crawford, Delaware, Knox, Marion, or Richland
- Service Date
- Outpatient Services: Eligibility determination is effective for 90 days from the initial service date, during which time a new eligibility determination need not be completed. The effective date for outpatient eligibility is to be documented on each account, under system notes.
- Inpatient Services: Eligibilty determination will be performed separately for each admission, unless the patient is readmitted within 40 days of discharge for the same underlying condition.
- Service must be a medically covered service per ODJFS guidelines
- Income Guidelines:
- Patients with income less than 100% of the current Federal Poverty Income Guidelines qualify for the HCAP program. (Refer to HCAP section on Page 1 of this policy)
- Patient must meet the income guidelines of 101%-175% of the current Federal Poverty Income Guidelines at the time of service for a 100% charity adjustment.
- Patients must meet the income guidelines of 176%-200% of the current Federal Poverty Income Guidelines at the time of service for a 75% discount.
- Patients must meet the income guidelines of 201%-225% of the current Federal Poverty Income Guidelines at the time of service for a 50% discount.
- Patients must meet the income guidelines of 226%-250% of the current Federal Poverty Income Guidelines at the time of service for a 25% discount.
- These discounts are applied via the Financial Aid Discount Worksheet (available from the CFO or the Business Office). Due to the Federal Poverty Income Guidelines changing annually, Morrow County Hospital routinely updates this worksheet.
- Family Size – Based on all dependents living in the household
- Patient cannot be a recipient of Medicaid or any other state Medicaid program.
HARDSHIP:
Discounts for hardship will be reviewed on a case-by-case basis and may be granted at the discretion of the Chief
Financial Officer and the Patient Accounts Manager.
NOTIFICATION OF FINANCIAL ASSISTANCE
Signs are posted at each patient registration location stating our compliance with the State of Ohio's Hospital Care Assurance Program (HCAP). Additionally the signage contains reference to the Morrow County Hospital's Charity Program. Information materials are available at registration locations and interpretive services can be arranged if the patient/guarantor does not speak English. Also, billing statements include information regarding HCAP and a financial assistance application to apply for the HCAP or Morrow County Hospital Charity Program.
OTHER DISCOUNTS
In order to encourage prompt payment, Morrow County Hospital offers a 15% discount on true self-pay accounts (no insurance) for which payment is received within 30 days of bill date. A 10% discount is available for co-payments or deductibles received within 30 days of bill date.
It is the policy of Morrow County Hospital that related parties of the hospital are not entitled to additional discounts other than as described above. Related parties include, but are not limited to, the follow groups and their families and associates: Morrow County Hospital employees, Trustees, Medical Staff members, and vendors. Employees violating this policy through the offering of additional discounts, waiving of co-pays and deductibles or the improper write-off of an account will be subject to disciplinary action.
Payment plans can be set up by calling the phone number located on the patient billing statement. Morrow County Hospital does not charge interest on outstanding balances.
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