Financial Services

Pomerene

Financial Services


IS MY INSURANCE ACCEPTED AT POMERENE?


Today, you have more choices than ever for your healthcare. Pomerene Hospital recognizes the significant decision families make when they select their healthcare insurance during their open enrollment time. The decision on which insurance company or plan is often difficult or confusing, therefore we want to share a few helpful tips to consider when choosing your healthcare plan:


  • If you want your insurance to cover your Pomerene Hospital physician and Pomerene services, make sure they participate in the plan you choose.
  • Understand your monthly premium. This is your monthly cost of ownership which is not covered by your insurance company.
  • Understand which services are covered under your selected plan.
  • Know up front of any out-of-pocket costs. These are costs associated with care received or services used which may require additional out-of-pocket costs such as co-pays, coinsurance and deductibles.
  • Pricing Information

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  • Accepted Health Insurance Plans

    • Commercial Insurance

      • Aetna (HMO,PPO,POS,EPO)
      • Amerihealth Caritas (MCD)
      • Anthem Commercial (Blue trad, Blue Access, Blue preferred)
      • Anthem MCR (HMO,PPO)
      • Aultcare (PPO,HMO,Aultman employee PPO)
      • Beech Street (Comm & Workers Comp)
      • Caresource MCR/MCD Dual
      • Cigna Comm (PPO,HMO)
      • First Health Comm (PPO)
      • Flora Health Network Comm (HMO)
      • Healthnet (Tricare Prime)
      • The Health Plan Comm (Hometown) HMO,PPO
      • Healthsmart Comm (HMO,PPO,ACCEL,WC)
      • Humana Comm (PPO)
      • MMO MCR ADV
      • MMO Comm (PPO,POS,)
      • Multiplan Comm (HMO,PPO)
      • National Provider Network (Comm, HMO)
      • Nationwide Comm (HMO)
      • Ohio Health Choice Comm (PPO,HMO)
      • Private Healthcare Systems / PHCS Comm (HMO)
      • Quality Care Partners Comm (HMO)
      • Summacare Comm (SC Premier, Prime, Plus, Select, Mercy Choice)
      • SCSecure
      • SCSupplemental Standard
      • SCSupplemental Select
      • Tricare
      • United Healthcare Comm (HMO,PPO)
      • United Healthcare VA-Optum (VA-CCN)


    • Medicare and Medicare Advantage

      • Aetna Medicare (Golden MCR Plan, Golden MCR Choice)
      • Buckeye Medicare (WellCare HMO, MyCare)
      • The Health Plan Medicare (HMO)
      • Humana Medicare (PPO,PFFS)
      • Molina Medicare (HMO, )
      • PrimeTime Medicare / AultCare (HMO)
      • SummaCare MCR :  SCMedicare
      • United Healthcare Medicare (AARP, Dual Complete, PPO,HMO)
      • Valor Healthplan Medicare (HMO)

    • Medicaid and Medicaid HMO

      • Anthem  Medicaid
      • Buckeye Medicaid (HMO)
      • Caresource Medicaid
      • Molina Medicaid ( HMO, MyCare)
      • Ohio Medicaid Amerihealth Carnitas
      • Paramount Medcaid
      • United Healthcare Medicaid (Duals, MyCare)

    Eligibility Guidelines

    Eligibility Guidelines


    • You must be a resident of Ohio.
    • Pomerene Hospital Charity Care is only available to residents of Holmes County.
    • You must complete and sign all applicable paperwork.
    • You must provide proof of income that would apply to all applicable family members.
    • If we determine that you may be eligible for Medicaid, or other assistance, you will be expected to apply for Medicaid before we can process the PHCC application. If you were denied Medicaid coverage, the denial letter is required.


    

    Financial assistance and charity care are secondary to ALL other financial resources available to patients. This may include:


    • Health Savings Account
    • Flexible Spending Account
    • Worker's Compensation
    • Medicare
    • Medicaid
    • Third Part Liability Situations (auto accidents/personal injury)
    • Other State, Federal, and Military Programs
    • Church Fund
    • Amish Aid


    If you are in need of financial assistance, please complete our Financial Assistance Application form. You may also view our Financial Aid Policy and our Plain Language Summary of Financial Assistance.

    Financial FAQs

    • What Is Included With "Family Size"?

      Family size includes the patient, patient's spouse whether they reside in the home or not, and ALL of the patient's children, natural or adopted under the age of 18. Grandparents, step-parents, and legal guardians are not considered part of a minor patient's "family". They must be related by birth or formal adoption in order to be considered. Both parents should be counted if the child is the patient, even if only one of them has been granted responsibility. Siblings who reside in the home can only be counted in the family size.

    • What Is Considered "Income"?

      Income would be considered as anything made from:

      • Employment/Wages
      • Unemployment
      • Alimony
      • Child support
      • Social Security Income
      • Disability Income
      • SSI
      • Distributions from a retirement account
      • Interest
      • Dividends on a non-retirement savings or brokerage account
      • Social Security Income
    • Who is Eligible for PHCC?

      Residents of Holmes County Who:


      • Meet the income criteria
      • Have completed an application
      • Have no health coverage or have coverage that only pays part of the bill
      • Are ineligible for any private or government sponsored coverage (such as Medicaid)
    • What Services are Covered Under PHCC?

      Only medically necessary and emergency health care services are covered.

    • If I Receive a Discount Off My Bill From PHCC, How Do I Set Up Payments For My Balance?

      Once your application has been processed, you must immediately set up payments for the balance, no longer than 10 days after notification. You can do so by contacting the Financial Counselor at (330) 674-1574, extension 1163 or the Billing Office at (330) 674-1584, extension 1744.

    Medicare Eligibility

    You may qualify for Medicare if:

    • You are age 65 or older
    • Are under age 65 and have a disability
    • Have End Stage Renal Disease

    


    The following links provide information about available healthcare coverage for those who are eligible:       


    Medicare's Official Website


    Medicare and You
    To Sign Up For Medicare


    The following links provide information about available healthcare coverage for those who are eligible.    


    Women, Infants & Children (WIC) Application
    • Medicaid for children, pregnant women and families.
    • This is an application for WIC services, Child and Family Health Services and to get assistance through the Bureau for Children with Medical Handicaps.


    Application for Cash, Food, and Medical Assistance
    Application for Help with Medicare Expenses


    Pricing Information

    Price Transparency

    Per Day Charges

    ICU: $2205

    Nursery: $992

    Maternity: $1050

    Private: $1029

    Monitored Bed: 1,281

    Swing Bed: 1,050


     The following list does not include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected and will be billed separately by your physician.


    Normal Delivery: $2,900

    Cesarean Section Delivery: $3,690

    Fetal Non-Stress Test: $400

    Labor Room Per Hour: $110


    Anesthesia Physician Fee Information may be obtained from:  


    Anesthesia Management Partners

    921 Sherwood Drive

    Lake Bluff, IL 60044

    1-800-444-6110

    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 or Emergency Department physicians who will bill separately for their services.


    Level 1: $278

    Level 2: $394

    Level 3: $541

    Level 4: $646

    Level 5: $966

    Critical Care First Hour: $1,391

    Operating Room charges are based on the complexity level, with Level 1 being the most basic, for a particular operation.


    LEVEL 1 FIRST 30 MINUTES:  $1,560.00

    LEVEL 1 EACH ADDITIONAL 15 MINUTES: $780.00

    LEVEL 2 FIRST 30 MINUTES: $1,716.00

    LEVEL 2 EACH ADDITIONAL 15 MINUTES: $858.00

    LEVEL 3 FIRST 30 MINUTES: $1,872.00

    LEVEL 3 EACH ADDITIONAL 15 MINUTES: $936.00

    LEVEL 4 FIRST 30 MINUTES: $2,028.00

    LEVEL 4 EACH ADDITIONAL 15 MINUTES: $1014.00

     

    ENDOSCOPY ROOM CHARGES

    LEVEL 2 ENDOSCOPY FIRST 30 MINUTES: $1,716.00

    LEVEL 2 ENDOSCOPY EACH ADDITIONAL 15 MIN: $858.00

    The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges depending on the services performed.


    Therapeutic Exercise per 15 Min.: $104

    Ultrasound per 15 Min.: $68

    Aquatic Therapy per 15 Min.: $78

    Gait Training per 15 Min.: $73

    Orthotics/Prosthetics per 15 Min.: $120

    Evaluation- Low: $189

    Electrical Stimulation Unattended: $62


    Respiratory Therapy Charges

    Arterial Blood Gas: $120

    Acapella Device: $188

    BiPap Per Day: $259

    Medication Nebulizer Initial: $229

    Oxygen Daily: $65

    Oxygen Set Up: $65

    Pulmonary Function Test Complete: $961

    Ventilator Management 1st Day: $702

    Pulse Ox: $41


    Sleep Lab Charges

    Sleep Lab without CPAP: $4,266

    Sleep Lab with CPAP: $4,482

    Home Sleep Test: $540


    Speech Therapy Charges

    Evaluation: $25

    Treatment: $203

    Evaluation Swallowing: $29

    Treatment Swallowing: $250


    Occupational Therapy Charges

    Therapeutic Charges per 15 min.: $104

    Fluidotherapy: $55

    Functional Capacity Test per 15 min.: $104

    Evaluation Low Complexity: $189

    Orthotic Training per 15 min: $120


    X-Ray & Radiological Charges

    Diagnostic

    Chest One View: $174

    Chest Two View: $239

    Screening Mammogram Digital: $263

    KUB: $250

    Lumbosacral Complete Min 4 Views: $473

    Pelvis AP: $229

    Bone Density Dexa Axial Skeleton: $286

    Cervical Spine Complete: $520

    Ankle Complete Unilateral: $321

    Foot Complete Unilateral: $328

    Hand Complete Unilateral: $3233

    Knee Complete Unilateral Min 4 Views: $364

    Hip Complete Unilateral Min 2 Views: $234

    Wrist Unilateral Min 3 Views: $328

    Shoulder Complete: $312

     

    Ultrasound

    Abdomen Complete: $702

    Abdomen Limited: $541

    Pelvis: $666

    Breast Bilateral: $333

    Breast Unilateral: $270

    Both Kidneys: $468

    Soft Tissue Head and Neck: $572

    Thyroid: $572

    OB Initial> 14 Weeks: $416

     

    Nuclear Medicine

    Gastric Emptying: $1,097

    Bone/Whole Body: $1024

    Thyroid Uptake and Scan: $1404

    Hida Scan: $1510

     

    CT

    Brain with/without Contrast: $1,976

    Abdomen and Pelvis with Contrast: $2,387

    Abdomen without Contrast: $1,196

    Chest without Contrast: $1,097

    Cervical Spine without Contrast: $1,300

     

    MRI

    Lumbar Spine without Contrast: $2.064

    Any Joint Lower without Contrast: $2,356

    Breast Bilateral with/without Contrast: $2,496

    Brain with/without Contrast: $2,834

    Cervical without Contrast: $2028

     

    MRA

    Brain or Neck without Contrast: $1,872

    Brain or Neck with Contrast: $2,184

     

    Vascular Ultrasound

    Vascular Ultrasound: $510

    Carotid: $806

    Venous Bilateral: $707

    Arterial Bilateral Duplex Upper Ext: $468

     

    Cardiology

    Echocardiogram Complete: $1,508

    Nuclear Stress (adenosine or Lexiscan): $3,838

    Exercise Stress: $681

    Transesophageal Echo (TEE): $2,184

    EKG: $135

    Holter Monitor: $518


    Laboratory Charges

    Amylase: $52

    APTT: $46

    Basic Metabolic Panel: $64

    Bilirubin Total: $37

    Blood Culture: $69

    BNP: $134

    BUN: $34

    C Reactive Protein: $62

    CBC No Diff: $44

    Complete Blood Count: $55

    Comprehensive Metabolic Panel: $131

    CPK: $52

    Depakene (Valproic Acid): $82

    Electrolytes Panel 4: $64

    Glucose: $32

    Glucose Bedside: $33

    Hematocrit: $22

    Hemoglobin: $21

    Hemoglobin Glycosylated (HGB A1C): $52

    Hepatic Panel: $82

    Iron: $46

    Lipid Panel: $96

    Magnesium: $52

    Occult Blood Stool: $28

    Pathology Level 4: $124

    Potassium $36

    Protime: $28

    PSA Total: $72

    PSA Cancer Screen: $60

    Renal Function Panel: $74

    Sedimentation Rate: $31

    Thyroid Stimulating Hormone (TSH): $93

    Troponin: $88

    Urinalysis: $37

    Urine Culture: $47

    Vitamin D: $77

    Venipuncture: $21



    CALL FOR MORE INFORMATION

    For general billing questions or to arrange a payment plan, please call 330-674-1584, ext. 1744

    330-674-1584 (ext 1744)
    Please find Pomerene Hospital’s Chargemaster attached below.


    Chargemaster FAQ

    Chargemaster is a comprehensive list of charges for each inpatient and outpatient service item provided by a hospital. It includes every test, exams, surgical procedure, room charge, supply, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.


    • Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid and those insurers then apply their contracted rates to the services that are billed.
    • Patients that do not have insurance, Pomerene Hospital has a financial assistance policy that applies discounts to the amounts charged. For more information on the Financial Assistance Policy, please contact our Financial Counselor at (330) 674-1584 ext. 1163.


    Disclaimer: The information provided in the file below, is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital, also known as a chargemaster. It is not a helpful tool for patients to comparison shop between hospitals or to estimate what total health care services are going to cost them out of their own pocket. For more information about the total cost of your care, please contact our Patient Financial Services at (330) 674-1584 ext. 1163.


    Click here for the  2024 Pomerene Hospital Standard Charges


    Click here for the  2024 Shoppable Services list


    Click here to view the Right to Good Faith Estimate


    Click here to view the Rights and Protections Against Surprise Medical Billing


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