Worried About Your Bill? We Can Help
Patient Payment Alternatives
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, MasterCard, 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 15%.
2. TIME PAYMENT PROGRAMS
The Time Payment 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.
Future Hospital Bills
As future hospital bills arise, you can simply charge 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!
Time Payments
Balances left to Patient's responsibility can be set upon monthly time payments. See Attachment B. Please contact a Financial Counselor for more information.
Attachment B
| <$50.00 | Full Amount Due |
|---|---|
| $51 - 100.00 | 2 Monthly Payments |
| $101 - 150.00 | 3 Monthly Payments |
| $151 - 200.00 | 4 Monthly Payments |
| $201 - 300.00 | 5 Monthly Payments |
| $301 - 350.00 | 6 Monthly Payments |
| $351 - 400.00 | 7 Monthly Payments |
| $401 - 500.00 | 8 Monthly Payments |
| $501 - 600.00 | 9 Monthly Payments |
| $601 - 700.00 | 10 Monthly Payments |
| $701 - 800.00 | 11 Monthly Payments |
| $801 - 999.00 | 12 Monthly Payments |
| $1000 - 1999.00 | 1 Year Plan |
| $2000 - 2999.00 | 2 Year Plan |
| $3000 - 3999.00 | 3 Year Plan |
| >$4000.00 | 4 Year Plan |
No Pre-Payment Penalties
You can always make double payments or pay-off your account early without interest or other penalties attached.
3. FINANCIAL SUPPORT PROGRAMS
Ohio Healthy Start
Monthly income guidelines as follows:
1 person: $1,164.00
2 people: $1,562.00
3 people: $1,959.00
4 people: $2,357.00
5 people: $2,754.00
For more information on Children's Health Insurance Plan please contact:
Ohio Department of Job & Family Services
Hospital Care Assistance Program (HCAP)
If your annual income is below the national poverty guidelines Fayette County Memorial
Hospital has a program that can help.
2008 Annual Federal Poverty Guidelines
* For family units with more than 8 members, add $3,600.00 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 200% 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 sf adjusted household income is equal to or less than 200%
of the Federal Poverty Guidelines
Based on the adjusted household income compared to the Federal Poverty Guidelines a discount will be given according to Attachment A. An additional incentive will be offered for payment in full within 10 days of approval of participation.
Payment Level or Discount Amount (Attachment A)
Charges $1 - $250 $251- $1500 $1501 - $2500 $> - $2500 0 - 100% HCAP 0 - 100% Poverty 101 - 120% Poverty
121 - 150% Poverty 151 - 200% Poverty *An additional reduction of up to 10% of the remaininq patient balance due may be granted if payment in full is received within 10 days of approval for community financial assistance.
Common Ouestions?
1. How do I apply for the HCAP or CFA?Your first step should be to contact our Financial Counselor at 333-2730. 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 time payment plan may be set up for the remainder of the balance QR the claim.
3. Can I also apply 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?
- Proof of Ohio residency
- 2 Bank Statements (CFA only)
- 3 months income prior to date of service
For further questions or additional information call one of our helpful financial counselors to set up an appointment to talk about your payment options, or click on the contact icon on our website home page to send us an e-mail.
Contact Numbers
Hospital Main Number:................335-1210
Financial Counselor: ................... 333-2730 or 333-2939
Billing Department:......................333-2725
Social Services:...........................333-2945
Ohio Dept. of Job & Family Services...335-0350