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
January 1, 2010.

 
Room & Board -- Per Day Charges

 

Charge

Medical/Surgical 602.20
PCU 1,105.25
Intensive Care 1,486.50

 

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 1 134.35
Level 2 189.80
Level 3 317.20
Level 4 479.80
Level 5 688.05
   

 

Operating Room Charges

Operating Room charges are based on the complexity level, with level 1 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

Scoping Procedure 1/2 h 693.65
Scoping Procedure 1 hr 1,674.85
Scoping Procedure 1 1/2 h 2,304.40
Scoping Procedure 2 hr 2,502.50
Scoping Procedure 2 1/2 hr 3,070.45
Surgery Charge Minor 1 hr 2,092.20
Surgery Charge Minor 1 1/2 hr 3,132.55
Surgery Charge Minor 2 hr 3,218.75
Surgery Charge Minor 2 1/2 hr 3,878.50
Surgery Charge Minor 3 hr 4,162.10
Surgery Charge Minor 3 1/2 hr 4,610.10
Surgery Charge Minor 4 hr 6,419.65
Surgery Charge Major 1 hr 3,292.30
Surgery Charge Major 1 1/2 hr 4,450.95
Surgery Charge Major 2 hr 5,499.30
Surgery Charge Major 2 1/2 hr 6,002.95
Surgery Charge Major 3 hr 7,586.90
Surgery Charge Major 3 1/2 hr 8,026.80
Surgery Charge Major 4 hr 9,055.70
Surgery Charge Major 4 1/2 hr 9,167.15
Surgery Charge Major 5 hr  10,049.95
Surgery Charge Major 5 1/2 hr 11,043.35
Surgery Charge Major 6 hr 13,844.95

 

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 min 85.35
Elec Stim Unattended 55.25
Manual Therapy 84.15
Elec Stim-MC 55.25
Initial PT Consult/Eval 106.20
Ultrasound each 15 min 70.40
Gait each 15 min 45.65
Therapeutic Proc/Group 27.95
Massage 48.00
Func/Kinetic Act Each 15 min   64.20
Neuro Muscle Reeducation 52.05
Iontophoresis each 15 min 47.90
Traction, Mechanical 35.30
Paraffin 35.10
Patient Re-Evaluation 69.25
ADL each 15 min  53.80

  

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 min 85.35
Manual Therapy 84.15
Kinetic Activities 64.20
Massage 15 min 48.00
Func Capacity Eval Each 48.75
Paraffin 35.10
Initial OT Consult 107.70
ADL Training each 15 min 53.80
Neuromuscular re-ed 52.05
Elec Stim Unattended 55.25
COGN Perceptual Mtr Trm 45.65
Ultrasound each 15 min 70.40
Transfer Training Each 15 min 53.80
Therapeutic Proc\Group 27.95
Orthotic Training Each 15 min 70.35

 

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 55.85
Pulm Rehab Evaluation 98.25
Pulm Rehab 6 min walk 65.50

 

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 218.30
Mammo CAD Screening 28.10
Mammo Screening 114.05
CT Head w/o Contrast 1,052.70
CT Abd w/o Contrast 1,052.70
CT Pelvis w/o Contrast 1,052.70
L Spine Min 2 Views 266.35
Chest PA Only 169.95
Foot Min 3 Views 203.80
Shoulder 2 Views 203.55
Ankle Min 3 Views 214.25
Knee 4 Views 254.40
Hand 3 Views 218.30
CT Pelvis w/Contrast 1,208.65
Wrist 3 or More Views 218.30
CT Abd w/Contrast 1,208.65
CT Spine 5 Views 336.00
CT Thorax w/Contrast 1,540.40
Hip Complete Min 2 View 197.65
US Single Organ 495.55
DXA Bone Density Scan 376.25
Cartoid Art Sonogram 485.90
Ribs Unilateral 225.90
CT Abs w/wo Contrast 1,364.55
Spine/Cervical w/o Contrast 1,217.15
KUB w/up PA Chest 425.25
Elbow 3 Views 218.30
US Venous Unilateral 545.85
T Spine AP & Lat 245.45
Knee AP & Lat 188.75
Abdomen/Kub 197.00
CT Head w/wo Contrast 1,364.55
   
   

 

Laboratory Charges

The following charges reflect the hospital's 30 most common laboratory procedures.

 

Charge

Venipuncture 29.20
CBC w Differential, Auto 90.05
Comp. Metabolic Panel 142.20
Prothromin Time 45.55
Basic Metabolic Pnl 98.65
CPK 75.60
Lipid Panel 147.35
Troponin l 114.05
CKMB 105.35
TSH-Thyroid Stim Hormone 194.60
Urinalysis 33.65
Creatinine Blood 59.55
Bun-Blood 54.95
Culture Urine 179.25
SGPT (ALT) 61.50
SGOT (AST) 59.85
Hemoglobin A1C 112.55
PTT 69.60
Electrolyte Panel 60.90
Culture Blood 179.25
Glucose 45.45
Potassium Blood 53.20
Lipase 79.80
Urinalysis W/Micro 38.15
Amylase 75.05
Hepatic Function Panel 128.30
Natriuretic Peptide-BNP 189.90
HGB 27.40
T4 Free 115.40
HCG-Urine Qual 85.00
   


 

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), Disability Assistance Program (DA) 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. The DA program, also operated by ODJFS, is a safety net for needy individuals who do not meet all of the eligibility requirements necessary to receive help from other federal and state benefit programs. 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.
     

DISABILITY ASSISTANCE:

  • The ODJFS determines eligibility and distributes DA cards to covered individuals.
     
  • Eligibility for recipients of disability assistance must be verified on a monthly basis for both inpatients and outpatients.
     
  • 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: Eligibility determination will be performed separately for each admission, unless the patient is readmitted within 45 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% 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 following 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.