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.

 
Room & Board -- Per Day Charges

 

Charge

Medical/Surgical 710.50
PCU 1,303.95
Intensive Care 1,753.00
Swing Bed 354.00

 

Labor & Delivery Charges

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

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

 

Physical Therapy Charges

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

 

Laboratory Charges

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


 

Hospital Billing Policies
  
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.

 
Procedure
  
Eligibility Requirements
 
HCAP:
 
  • Residency Requirement – The patient must be voluntarily living in the state of Ohio.
  • Service Date
    1. 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.
    2. 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
    1. 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.
    2. 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:
    1. 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)
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.