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.

Accepted Health Insurance Plans

  • Commercial Insurance

    • Aetna (HMO,PPO,POS,EPO)
    • Anthem (Blue trad, Blue Access, Blue preferred)
    • Anthem Marketplace (Pathway X HMO, Pathway X Tiered)
    • Aultcare (PPO,HMO,Aultman employee PPO)
    • Beech Street
    • Cigna (PPO,HMO)
    • First Health (PPO)
    • Healthsmart (HMO,PPO,ACCEL,WC)
    • Humana (PPO)
    • Medical Mutual of Ohio (PPO,POS, HMO)
    • Multiplan (HMO,PPO)
    • National Provider Network (HMO)
    • Nationwide (HMO)
    • Ohio Health Choice (PPO,HMO)
    • Private Healthcare Systems / PHCS (HMO)
    • Quality Care Partners (HMO)
    • Summacare (SC Premier, Prime, Plus, Select, Mercy Choice)
    • The Health Plan (Hometown) HMO,PPO
    • Tricare
    • United Healthcare (HMO,PPO)
    • VA Community Care Network (UHC Optum)
  • Medicare and Medicare Advantage

    • Aetna (HMO, PPO, HMO D-SNP, HMO-POS, Regional PPO)
    • Anthem (HMO,PPO)
    • Caresource (Duals/MyCare)
    • Humana (PPO,PFFS)
    • Medical Mutual of Ohio (HMO, HMO-POS, PPO)
    • Molina Healthcare of Ohio (HMO D-SNP)
    • PrimeTime/AultCare (HMO)
    • SummaCare (HMO, HMO-POS)
    • The Health Plan (HMO, HMO D-SNP, PPO)
    • United Healthcare (AARP, Dual Complete, PPO,HMO)
    • United Healthcare Plan Community Dual Complete (HMO-POS D-SNP)
    • Valor Healthplan (HMO)

  • Medicaid and Medicaid HMO

    • Anthem/Paramount
    • Buckeye (HMO)
    • Caresource (MyCare)
    • Molina ( HMO, MyCare)
    • Ohio Medicaid Amerihealth Carnitas
    • United Healthcare Community (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 Party 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, 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: $2293

Nursery: $1032

Maternity: $1092

Private: $1080

Monitored Bed: 1,345

Swing Bed: 1,092


 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: $3,106

Cesarean Section Delivery: $4,452

Fetal Non-Stress Test: $433

Labor Room Per Hour: $155


Anesthesia Physician Fee Information may be obtained from:  


Pomerene Anesthesia Services

844 Boulevard St.

Dover, Ohio 44622

330-473-661

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: $292

Level 2: $414

Level 3: $584

Level 4: $704

Level 5: $1,063

Critical Care First Hour: $1,516

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: $1,654.00

LEVEL 1 EACH ADDITIONAL 15 MINUTES: $827.00

LEVEL 2 FIRST 30 MINUTES: $1,888.00

LEVEL 2 EACH ADDITIONAL 15 MINUTES: $909.00

LEVEL 3 FIRST 30 MINUTES: $2,153.00

LEVEL 3 EACH ADDITIONAL 15 MINUTES: $992.00

LEVEL 4 FIRST 30 MINUTES: $2,332.00

LEVEL 4 EACH ADDITIONAL 15 MINUTES: $1060.00




ENDOSCOPY ROOM CHARGES

LEVEL 2 ENDOSCOPY FIRST 30 MINUTES: $1,785.00

LEVEL 2 ENDOSCOPY EACH ADDITIONAL 15 MIN: $893.00

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.: $108

Ultrasound per 15 Min.: $71

Aquatic Therapy per 15 Min.: $81

Gait Training per 15 Min.: $76

Orthotics/Prosthetics per 15 Min.: $125

Evaluation - Low: $186

Electrical Stimulation Unattended: $64


Respiratory Therapy Charges

Arterial Blood Gas: $252

Acapella Device: $204

BiPap Per Day: $269

Medication Nebulizer Initial: $273

Oxygen Daily: $60

Oxygen Set Up: $60

Pulmonary Function Test Complete: $1,033

Ventilator Management 1st Day: $730

Pulse Ox: $42


Sleep Lab Charges

Sleep Lab without CPAP: $4,607

Sleep Lab with CPAP: $5,020

Home Sleep Test: $589


Speech Therapy Charges

Evaluation: $262

Treatment: $217

Evaluation Swallowing: $314

Treatment Swallowing: $268


Occupational Therapy Charges

Therapeutic Charges per 15 min.: $108

Fluidotherapy: $59

Functional Capacity Test per 15 min.: $108

Evaluation Low Complexity: $197

Orthotic Training per 15 min: $125


X-Ray & Radiological Charges

Diagnostic

Chest One View: $181

Chest Two View: $258

Screening Mammogram Digital: $335

KUB: $260

Lumbosacral Complete Min 4 Views: $511

Pelvis AP: $238

Bone Density Dexa Axial Skeleton: $315

Cervical Spine Complete: $541

Ankle Complete Unilateral: $347

Foot Complete Unilateral: $354

Hand Complete Unilateral: $346

Knee Complete Unilateral Min 4 Views: $393

Hip Complete Unilateral Min 2 Views: $243

Wrist Unilateral Min 3 Views: $341

Shoulder Complete: $337


Ultrasound

Abdomen Complete: $730

Abdomen Limited: $649

Pelvis: $693

Breast Bilateral: $351

Breast Unilateral: $338

Both Kidneys: $505

Soft Tissue Head and Neck: $686

Thyroid: $686

OB Initial> 14 Weeks: $428


Nuclear Medicine

Gastric Emptying: $1,141

Bone/Whole Body: $1030

Thyroid Uptake and Scan: $1429

Hida Scan: $1780


CT

Brain with/without Contrast: $2,055

Abdomen and Pelvis with Contrast: $2,411

Abdomen without Contrast: $1,244

Chest without Contrast: $1,141

Cervical Spine without Contrast: $1,365


MRI

Lumbar Spine without Contrast: $2,167

Any Joint Lower without Contrast: $2,450

Breast Bilateral with/without Contrast: $2,596

Brain with/without Contrast: $2,947

Cervical without Contrast: $2,109


MRA

Brain or Neck without Contrast: $1,947

Brain or Neck with Contrast: $2,271


Vascular Ultrasound

Vascular Ultrasound: $530

Carotid: $838

Venous Bilateral: $735

Arterial Bilateral Duplex Upper Ext: $562


Cardiology

Echocardiogram Complete: $1,568

Nuclear Stress (Lexiscan): $4,056

Exercise Stress: $708

Transesophageal Echo (TEE): $2,272

EKG: $140

Holter Monitor: $552


Laboratory Charges

Amylase: $54

APTT: $48

Basic Metabolic Panel: $67

Bilirubin Total: $38

Blood Culture: $73

BNP: $139

BUN: $35

C Reactive Protein: $64

CBC No Diff: $46

Complete Blood Count: $57

Comprehensive Metabolic Panel: $136

CPK: $54

Depakene (Valproic Acid): $85

Electrolytes Panel 4: $67

Glucose: $34

Glucose Bedside: $34

Hematocrit: $23

Hemoglobin: $22

Hemoglobin Glycosylated (HGB A1C): $53

Hepatic Panel: $85

Iron: $48

Lipid Panel: $100

Magnesium: $54

Occult Blood Stool: $29

Pathology Level 4: $129

Potassium $37

Protime: $29

PSA Total: $75

PSA Cancer Screen: $62

Renal Function Panel: $77

Sedimentation Rate: $32

Thyroid Stimulating Hormone (TSH): $97

Troponin: $92

Urinalysis: $38

Urine Culture: $50

Vitamin D: $75

Venipuncture: $22



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 2025 Pomerene Hospital Standard Charges


Click here for the  2025 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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