Patient Billing
Information
At Mercer
Health, we believe you have a right to know how much you
or your insurance company may be charged for many of
our essential services. This list contains our charges
for room and board, emergency department, operating room,
newborn delivery, physical therapy and other procedures.
We charge 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 charges
are correct as of April 1, 2008.
Room and Board -
Per Day Charges |
| |
|
Charges |
Daily Room Charge |
$457.00 |
Intensive Care |
$1131.00 |
Nursery |
$497.00 |
Maternity Daily Room |
$560.00 |
Nursing Care - Per Day Charges
|
|
|
|
Care Level ICU ll |
$331.20 |
Care Level ICU lll |
$437.60 |
Care Level ICU lV |
$762.85 |
Care Level M/S ll |
$247.60 |
Care Level M/S lll |
$286.30 |
Care Level OB ll |
$311.70 |
Care Level OB lll |
$374.70 |
Care Level OB lV |
$794.75 |
Care Level TELE ll |
$266.15 |
Care Level TELE lll |
$348.90 |
Nursery Special Care |
$750.00
|
Observ ICU INI/HR |
$228.80 |
Observ ICU SUBS/HR |
$96.70 |
Observ M/S INI/HR |
$123.80 |
Observ M/S SUBS/HR |
$35.35
|
Observ TELE INI/HR |
$149.25 |
Observ TELE SUBS/HR |
$44.50 |
Operating Room Charges
|
|
|
|
Surgery Level 1 |
$990.00 |
Surgery Level 2 |
$1290.00 |
Surgery Level 3 |
$1680.00 |
Surgery Level 4 |
$2210.00 |
Surgery Level 5 |
$2590.00 |
Surgery Level 6 |
$3120.00 |
Surgery Level 7 |
$3790.00 |
Emergency
Department Charges
|
|
|
|
Emergency Room Level 1 |
$94.00 |
Emergency Room Level 2 |
$121.60 |
Emergency Room Level 3 |
$180.15 |
Emergency Room Level 4 |
$550.50 |
Emergency Room Level 5 |
$788.15 |
Emergency Room Level 6 |
$1100.95 |
Laboratory
Charges
|
| |
|
|
1 UN Compatibility |
$64.35 |
Amylase, Serum |
$62.85 |
Bacti ID EA Aerobic |
$40.80 |
Basic Metabolic Panl |
$181.35 |
Blood Type ABO |
$20.25 |
BNP Peptide |
$362.25 |
BUN |
$22.70 |
CBC with Auto Diff |
$67.15 |
Comprehensive Panel |
$317.35 |
Coombs Indirect |
$83.65 |
Creatinine |
$22.70 |
Culture, Blood |
$118.20 |
Culture, Urine |
$72.50 |
Glucose |
$24.90 |
Lipase |
$82.75 |
Lipid Profile |
$129.10 |
Liver/Hepatic Panel |
$158.65 |
Pap Thin Prep. Screen |
$119.25 |
Path Tissue Spec IV |
$152.00 |
Pro Time |
$44.30 |
PTT |
$54.25 |
RH Factor |
$32.25 |
Sensitivity, Antibiot |
$91.25 |
SGPT |
$22.70 |
T4 Free (direct) |
$116.20 |
Troponin-l |
$94.60 |
TSH |
$158.75 |
Urinalysis Routine |
$52.50 |
Venipuncture Outhos |
$25.50 |
Venipuncture Blood Draw |
$12.45 |
X-Ray and
Other Radiology
Charges
|
| |
|
|
ABD W Contrast |
$1215.90 |
ABD WO Contrast |
$1079.95 |
Abdomen 1 View/KUB |
$128.20 |
Abdomen OBSTR Series |
$256.45 |
Ankle (minimum of 3 views) |
$195.65 |
Bone Density |
$307.85 |
Cardiac Doppler CFM |
$195.35 |
Cardiac Doppler PW-C |
$264.85 |
Chest PA & Lateral X |
$188.30 |
Chest PA X-Ray |
$144.45 |
Echo M-Mode & 2D |
$560.00 |
EKG |
$126.40 |
Foot (minimum of 3 views) |
$201.15 |
Gallbladder Ultrasound |
$653.30 |
Hand (minimum of 3 views) |
$195.65 |
Head w/o Contrast |
$998.15 |
Hip AP & Lateral X-Ray |
$181.90 |
Mammography Cad Screen |
$27.75 |
Mammography BI Screen |
$137.65 |
Mammography Unilat |
$125.25 |
MRI Low Ex. Joint w/o |
$1850.40 |
Pelvis Ultrasound |
$421.15 |
Pelvis w/ Contrast |
$1215.90 |
Pelvis w/o Contrast |
$1079.95 |
Shoulder Comp. (minimum of 2 views) |
$212.20 |
Spine Cervical 2/3 View |
$208.90 |
Spine Lumbar 2/3/ View |
$242.05 |
Stress Test Maximal |
$569.30 |
Thorax w/ Contrast |
$1215.90 |
Wrist (minimum of 3 views) |
$212.20 |
Pulmonary Therapy Charges
|
| |
|
|
Arterial Puncture |
$8.55 |
Breath Alcohol |
$103.00 |
C.O. Diffusion |
$119.60 |
Initial Inhaler TX. |
$18.85 |
Initial NEB TX |
$49.80 |
NEB Display Set Up |
$23.80 |
Oxygen Oximetry |
$52.35 |
Oxygen Per Hour |
$13.60 |
Plethysmography |
$117.80 |
Pre/Post PFT |
$353.40 |
Reg. 02 Set-up Display |
$22.65 |
Spirometer Display |
$14.20 |
Spirometery / MVV |
$176.55 |
Subsequent Flutter TX |
$52.35 |
Subsequent Inhale TX |
$15.50 |
Subsequent NEB TX |
$38.75 |
Subsequent PERC TX |
$52.35 |
Ventilator (per hour) |
$62.90 |
Physical Therapy Charges
|
| |
|
|
CPM Adjust - P.T. (15min.) |
$54.25 |
E-Stim. Unatt-P.T. |
$48.30 |
E-Stim - pt & M.O.D. |
$58.80 |
Eval P.T. Minor |
$83.80 |
Eval-O.T. Major |
$184.55 |
Eval-O.T. Minor |
$94.15 |
Eval-P.T. Major |
$164.25 |
Ex - 15min - O.T. |
$58.15 |
Ex - 15min - P.T. |
$58.15 |
Ex - 15min - P.T., B.R. |
$58.15 |
Ex - 15min - P.T., PED |
$50.65 |
Ex - Aquatic - 15min - P.T., B.R. |
$46.25 |
Ex - Aquatic - 15min - G.R.- P.T., B.R. |
$41.85 |
Ex - Group P.T., B.R. |
$43.40 |
Fluid Other Compr. - O.T. |
$58.15 |
Gait Train 15M - P.T. |
$54.60 |
Iontophoresis 15M - P.T. |
$87.30 |
Man. Thertech 15min - P.T. |
$54.85 |
Massage 15min - P.T. |
$32.95 |
O.T. Onsite - 15min |
$87.20 |
Physical Therapy Onsite - 15min |
$87.20 |
Self Care/Home 15min - O.T |
$46.45 |
S.P. TX - Minor |
$76.75 |
Therapy Activities P.T. |
$27.20 |
Traction Cervical - P.T. |
$44.70 |
Ultrasound - P.T. 15min |
$46.20 |
US E Stim - P.T. 15min |
$50.40 |
W.K. Con P.T. G.R-B.R.-1hour |
$73.25 |
W.P. EXT. STRLWound |
$85.50 |
| |
Billing Information for Website per OHA
Billing
Office Telephone Numbers:
419-678-5151 Main Office
419-678-5148 Financial Advisor (self pay/HCAP/payment
plans)
419-678-5159 Anesthesia Billing
419-678-5109 Medicaid Biller
419-678-5102 Medicare Biller (Last Name A-K)
419-678-5108 Medicare Biller (Last Name L-Z)
419-678-5121 Worker’s Compensation/UHC/Goodyear/UMR Biller
419-678-5151 Coresource/Crown/Reynolds & Reynolds Biller
419-678-5103 All other Commercial Insurances (Last Name
A-K)
419-678-5190 All other Commercial Insurances (Last Name
L-Z)
419-678-5115 Director of Patient Accounts or email ksiefring@Mercer-health.com
Department Fax Number 419-678-5643
Office Hours of Patient
Accounts (Billing):
Monday – Friday from 8:00 a.m. to 5:30 p.m. or leave
a voicemail after hours with a time for us to contact you.
Our Office is located on the 1st Floor
next to the Main Lobby of Mercer County Community Hospital 800 W. Main Street,
Coldwater, OH 45828.
Hospital Care Assurance
Program (Free Care) and Charity Care
Program (Discounted
Care) Policies:
Under the provisions of section 5112.17 of the Ohio Revised
Code, Mercer County Community Hospital shall provide basic,
medically necessary, hospital-level services free of charge
to any non-Medicaid Ohio resident, who is either covered by
Disability Assistance or has a family income at or below the
Federal Poverty Guideline on the date of service. This provision
is referred to as the Ohio Hospital Care Assurance Program
(HCAP). Mercer County Community Hospital has expanded their
own Hospital Charity Care Program to include all billed services
excluded by HCAP and a sliding scale discount for incomes
above 100% the federal poverty guideline up to 150%. It shall
also include all billed services on a single encounter that
exceed one year’s family gross income for those that
don’t qualify under the poverty guidelines. To apply
for such assistance, consumers must complete, sign and return
the application located on the back of their statement letters
to the Patient Accounts Department, Mercer County Community
Hospital, 800 West Main Street, Coldwater, OH 45828 along
with proof of income. There is no time frame requirement to
apply. As long as consumer can show proof of income receiving
prior to date of service, they are eligible to apply for the
program for any account at any time. For assistance in completing,
questions regarding the application or to receive a new application,
consumers may call our Financial Advisor at 419-678-5148 or
Patient Accounts Office at 419-678-5151. Click
here to view a printable PDF HCAP form.
Payment Plans:
Mercer Health does offer interest free payment plans for
those situations were payment in full can not be made due
to financial situation or unexpected medical
expenses. For accounts to be set up on a payment plan, consumers may call our
Financial Advisor at 419-678-5148 or the Patient Accounts Office at 419-678-5151
to speak to an account representative. Payment booklets are available to track
and remind of payment due dates.
Credit/Bank Cards:
Mercer Health does accept payment by credit/bank card for
VISA, Mastercard and Discover. Payment can be made by telephone
by calling our Patient Accounts Office
at 419-678-5151 or our Financial Advisor at 419-678-5148 or by mailing the completed
bottom section of our statement letter to Mercer County Community Hospital 800
W. Main Street, Coldwater, OH 45828. For those customers on a payment plan and
upon completion of an authorization form, our office can automatically deduct
your monthly payment from your credit/bank card for your convenience.
For an
Itemized Listing/Statement of Charges:
For an itemized listing/statement of your detailed charges,
consumers can call our Patient Accounts Office at 419-678-5151
or send a written request to Mercer
County Community Hospital- Patient Accounts Department, 800 W. Main Street, Coldwater,
OH 45828 or
fax to 419-678-5643.
Other Billing Agencies:
In addition to the technical billing for all services rendered
at Mercer County Community Hospital, our Billing Office
also performs the professional billing
services for the Emergency Room Physicians, Doctor’s Urgent Care Physicians,
and the Anesthesiologists. For all other professional services, you will be billed
by the physician offices directly. Below are a few of the other common professional
services you may receive bills.
The Radiologist bill is separately billed by
Lima Radiology Associates and their billing office telephone
number is 800-444-3387.
The mailing address is P.O.
Box 5128, Lima, OH 45802.
The Pathologist bill is separately billed by
Grandlake Pathology - Dr. Fishbein and their billing office
telephone
number is 800-873-7909. The mailing address
is P.O. Box 96, Coldwater, OH 45828.
The Cardiologist bill is separately billed
by Dr. Ranga Inc. – Dr. Kakarla
and their billing office number is 419-629-3663. The mailing address is P.O.
Box 98, New Bremen, OH 45869.
The Sleep Study Interpretations are billed
by Dayton Lung & Sleep Medicine
and their billing office telephone number is 800-350-0322- The mailing address
is P.O. Box 634857 Cincinnati, OH 45263.
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