Charity Guidelines

Worried About Your Bill? We Can Help

Patient Payment Alternatives

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If you have insurance, Fayette County Memorial Hospital bills your insurance carrier according to information provided at registration. Any balances left after your insurance company pays the hospital are your responsibility.

When paying any balance, you have the following options:

1. PAYMENT IN FULL

You can make payment through the following means:

• Cash
• Personal Check
• Money Order
• VISA, Master Card, Discover Card, (Debit or Credit)

Send payments or make inquiries to:

Fayette County Memorial Hospital
Patient Accounting
1430 Columbus Avenue
Washington Court House, OH 43160

*Prompt Payment Incentive For uninsured patients, if payment is received within 14 days, FCMH will reduce the balance by 20%.

2. H.E.L.P. PATIENT LOANS

The HELP Patient Loan Program offers patients attractive payment options.

Guaranteed Line of Credit
If you have a source of income, you are automatically qualified.

Affordable Payments
Manageable monthly payments up to a 25 month term.

No Pre-Payment Penalties
You can always make double payments or pay-off your account early without interest or other penalties attached.

Future Hospital Bills
As future hospital bills arise, you can simply add them to your time payment account.

Easy Enrollment
You will not be subject to a formal credit check. For most people, if you have a source of income…YOU QUALIFY!

3. 90 DAY INTEREST FREE LOAN

FCMH offers an in-house payment plan which is interest free if paid within 90 days.

Call a financial counselor today to take advantage of one of our loan programs.

4. FINANCIAL SUPPORT PROGRAMS

HOSPTIAL CARE ASSISTANCE PROGRAM (HCAP)

If your annual income is below the National Poverty Guidelines, Fayette County Memorial Hospital has a program that can help.

2017 Annual Federal Poverty Guidelines

Family Size      Income Guidelines
1                      $12,060
2                      $16,240
3                      $20,420
4                      $24,600
5                      $28,780
6                      $32,960
7                      $37,140
8                      $41,320

For family units with more than 8 members, add $4,180 for each additional member.

COMMUNITY FINANCIAL ASSISTANCE PROGRAM (CFA)

Fayette County Memorial Hospital believes that a discount should be offered to all patients whose adjusted household income is equal to or less than 300% of the Federal Poverty guidelines.

Eligibility for CFA will be as follows:

•Determination of qualification for other programs such as Medicaid or HCAP
•Determination of liquid assets
•Determination of adjusted household income is equal to or less than 300% of the Federal Poverty Guidelines

Common Questions?

1. How do I apply for the HCAP or CFA?

Your first step should be to contact one of our Financial Counselors. At that time, the Counselor will be able to review with you the required information needed for completion of your application.

2. What if I still cannot afford the balance of the claim after the CFA discount?

A payment plan may be set up for the remainder of the balance on the claim.

3. Can I also apply to the HCAP or CFA program for claims that are currently in Bad Debt?

Depending on the age of the account, the Financial Counselor will be able to assist you with these time frames.

4. What information is required for the application process?

◦Two (2) Bank Statements (CFA only)
◦Three (3) months income prior to date of service

PATIENT CONTACT INFORMATION

Your Name:
Your Street Address:
Your City, State & Zip:
Best Phone to Reach You:
Hospital Account Number(s), if known:

Send to:
Fayette County Memorial Hospital
Patient Accounting
1430 Columbus Avenue, WCH, OH 43160

OUR CONTACT INFORMATION

FCMH Operator: (740) 335-1210

Financial Counselors
Brenda: (740) 333-2730

HELP Financial: (800) 752-9613
Billing Department: (740) 333-2725
Social Services: (740) 333-2945
Ohio Dept. of Job & Family Services: (740) 335-0350

*Call one of our helpful financial counselors to set up an appointment to talk about your options, or print out a copy of this information here, fill out the contact information section, circle the option that you would like more information on, mail it to the Hospital, and we’ll call you at the phone number provided.