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
April 15, 2008.

 
Room & Board -- Per Day Charges

 

Charge

Medical/Surgical $533.45
Medical/Surgical Private 546.90 
PCU 979.05
PCU Private 1,052.20
Intensive Care 1,316.75
Isolation 567.20
   

 

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 $108.90
Level 2 168.10
Level 3 261.05
Level 4 334.75
Level 5 609.50
Critical Care 900.00

 

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 $614.45
Scoping Procedure 1 hr 1,483.60
Scoping Procedure 1 1/2 h 2,041.25
Scoping Procedure 2 hr 2,216.75
Scoping Procedure 2 1/2 hr 2,719.85
Surgery Charge Minor 1 hr 1,853.30
Surgery Charge Minor 1 1/2 hr 2,774.90
Surgery Charge Minor 2 hr 2,851.20
Surgery Charge Minor 2 1/2 hr 3,435.65
Surgery Charge Minor 3 hr 3,686.85
Surgery Charge Minor 3 1/2 hr 4,083.70
Surgery Charge Minor 4 hr 5,686.60
Surgery Charge Major 1 hr 2,916.40
Surgery Charge Major 1 1/2 hr 3,942.70
Surgery Charge Major 2 hr 4,871.35
Surgery Charge Major 2 1/2 hr 5,317.50
Surgery Charge Major 3 hr 6,720.60
Surgery Charge Major 3 1/2 hr 7,110.30
Surgery Charge Major 4 hr 8,021.70
Surgery Charge Major 4 1/2 hr 8,120.40
Surgery Charge Major 5 hr  8,902.45
Surgery Charge Major 5 1/2 hr 9,782.40
Surgery Charge Major 6 hr 12,264.10

 

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 $75.60
Elec Stim Unattended 48.90
Manual Therapy 74.55
Elec Stim-MC 48.90
Initial PT Consult/Eval 94.10
Ultrasound each 15 min 62.35
Gait each 15 min 40.40
Therapeutic Proc/Group 24.75
Massage 42.55
Func/Kinetic Act Each 15 min   56.85
Neuro Muscle Reeducation 46.10
Iontophoresis each 15 min 42.45
Traction, Mechanical 31.25
Paraffin 31.10
Patient Re-Evaluation 61.35
ADL each 15 min  47.65

  

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 $75.60
Manual Therapy 74.55
Kinetic Activities 56.85
Massage 15 min 42.55
Func Capacity Eval Each 43.20
Paraffin 31.10
Initial OT Consult 95.40
ADL Training each 15 min 47.65
Neuromuscular re-ed 46.10
Elec Stim Unattended 48.90
COGN Perceptual Mtr Trm 40.40
Ultrasound each 15 min 62.35
Transfer Training Each 15 min 47.65
Therapeutic Proc\Group 24.75
Orthotic Training Each 15 min 62.30

 

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 $49.50
Pulm Rehab Evaluation 87.05
Pulm Rehab 6 min walk 58.05

 

X-Ray & Radiological Charges

The following charges reflect the hospital's 30 most common x-ray and radiological procedures.

 

Charge

Chest $193.40
Mammo CAD Screening 26.50
Mammo Screening 107.60
Chest PA Only 150.55
CT Head w/o Contrast 932.50
L Spine Min 2 Views 235.90
Foot Min 3 Views 180.50
KUB w/UP PA Chest 376.70
C Spine 5 Views 297.65
Ankle Min 3 Views 189.75
CT Abd w/o Contrast 932.50
CT Pelvis w/o Contrast 932.50
CT Pelvis w/Contrast 1,070.65
Hip Complete Min 2 View 175.05
Fluoro Guide, Needle Loc 486.15
Hand 3 Views 193.40
US Single Organ 438.95
CT Abd w/Contrast 1,070.65
Wrist 3 or More Views 193.40
Knee 4 Views 225.35
CT Abd w/wo Contrast 1,208.75
Knee - AP & Lat 167.20
Shoulder 2 Views 180.35
CT Thorax w/Contrast 1,364.50
Cartoid Art Sonogram 430.40
T-Spine AP & Lat 217.40
Fluoro Guide Needle Plm 563.95
US Venous Unilateral 483.50
Finger 2 Views 139.65
Ribs Unilateral 200.10

 

Laboratory Charges

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

 

Charge

Venipuncture $25.85
CC w Differential, Auto 79.75
Prothromin Time 40.35
Basic Metabolic Pnl 87.35
Urinalysis 29.80
Comp Metabolic Panel 125.95
Creatinine Blood 52.50
Troponin I 101.05
CKMB 93.35
Bun-Blood 48.70
Lipid Panel 130.50
CPK 66.95
TSH 172.40
Myoglobin 132.50
Electrolyte Panel 53.95
PTT 61.65
Hemoglobin A1C 99.70
Culture-Urine 158.80
Glucose 40.30
SGOT (AST) 53.00
Hepatic Function Panel 113.65
SGPT (ALT) 54.45
Culture-Blood 158.80
Amylase-Blood 66.50
Potassium Blood 47.15
Lipase 70.70
HGB 24.25
Rapid Strep Screen 123.15
HCT 24.25
Natriuretic Peptide-BNP 158.20


 

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.