Pomerene Hospital | Financial Services | Hospital Financial Services Get in touch 330-674-1015 330-674-1015 330-674-1015 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 o ut-of-pocket costs such as co-pays, coinsurance and deductibles. Accepted Health Insurance Plans Button Financial Assistance Financial FAQs Medicare Button Medicaid Button Pricing Information 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) Anthem I MyCare OHIO Full Dual Advantage Caresource (Duals/MyCare) CareSource MyCare Ohio Humana (PPO,PFFS) Medical Mutual of Ohio (HMO, HMO-POS, PPO) Molina Complete Care for MyCare Ohio 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 I MyCare OHIO Full Dual Advantage Anthem/Paramount Buckeye (HMO) Caresource (MyCare) CareSource MyCare Ohio Molina ( HMO, MyCare) Molina Complete Care for MyCare Ohio 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 The official U.S. government site for Medicare is www.medicare.gov/ Medicare and You To Sign Up For Medicare Apply online at Social Security Visit your local Social Security office. Call Social Security at 1-800-772-1213 If you worked for a railroad, call the RRB at 1-877-772-5772 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 Medicaid for older adults or people who are blind or disabled. This is also an application for cash, medical and/or food stamp assistance for all individuals. This application is also used for Refugee Medical Assistance programs Application for Help with Medicare Expenses For people who have Medicare and limited income: This program helps pay for Medicare premiums, coinsurance, and deductibles. Medicaid Eligibility Click here to visit the Ohio Department of Job and Family Services Medicaid Consumer Guide Medicaid for Older Adults and People with Disabilities Medicaid Premium Assistance Pricing Information Price Transparency Per Day Charges ICU: $2408 Nursery: $1073 Maternity: $1136 Private: $1124 Monitored Bed: 1,439 Swing Bed: 1,136 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: $3,199 Cesarean Section Delivery: $5,261 Fetal Non-Stress Test: $446 Labor Room Per Hour: $160 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: $308 Level 2: $437 Level 3: $616 Level 4: $743 Level 5: $1,121 Critical Care First Hour: $1,650 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: $1,786.00 LEVEL 1 EACH ADDITIONAL 15 MINUTES: $827.00 LEVEL 2 FIRST 30 MINUTES: $2,115.00 LEVEL 2 EACH ADDITIONAL 15 MINUTES: $927.00 LEVEL 3 FIRST 30 MINUTES: $2,368.00 LEVEL 3 EACH ADDITIONAL 15 MINUTES: $1,022.00 LEVEL 4 FIRST 30 MINUTES: $2,565.00 LEVEL 4 EACH ADDITIONAL 15 MINUTES: $1134.00 ENDOSCOPY ROOM CHARGES LEVEL 2 ENDOSCOPY FIRST 30 MINUTES: $1,839.00 LEVEL 2 ENDOSCOPY EACH ADDITIONAL 15 MIN: $920.00 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.: $120 Ultrasound per 15 Min.: $73 Aquatic Therapy per 15 Min.: $85 Gait Training per 15 Min.: $80 Orthotics/Prosthetics per 15 Min.: $129 Evaluation - Low: $200 Electrical Stimulation Unattended: $66 Respiratory Therapy Charges Arterial Blood Gas: $277 Acapella Device: $213 BiPap Per Day: $300 Medication Nebulizer Initial: $273 Oxygen Daily: $60 Oxygen Set Up: $60 Pulmonary Function Test Complete: $1,092 Ventilator Management 1st Day: $780 Pulse Ox: $44 Sleep Lab Charges Sleep Lab without CPAP: $4,837 Sleep Lab with CPAP: $5,271 Home Sleep Test: $630 Speech Therapy Charges Evaluation: $275 Treatment: $230 Evaluation Swallowing: $325 Treatment Swallowing: $276 Occupational Therapy Charges Therapeutic Charges per 15 min.: $120 Fluidotherapy: $61 Functional Capacity Test per 15 min.: $111 Evaluation Low Complexity: $205 Orthotic Training per 15 min: $129 X-Ray & Radiological Charges Diagnostic Chest One View: $190 Chest Two View: $268 Screening Mammogram Digital: $349 KUB: $268 Lumbosacral Complete Min 4 Views: $526 Pelvis AP: $245 Bone Density Dexa Axial Skeleton: $324 Cervical Spine Complete: $557 Ankle Complete Unilateral: $361 Foot Complete Unilateral: $365 Hand Complete Unilateral: $356 Knee Complete Unilateral Min 4 Views: $410 Hip Complete Unilateral Min 2 Views: $250 Wrist Unilateral Min 3 Views: $351 Shoulder Complete: $355 Ultrasound Abdomen Complete: $800 Abdomen Limited: $700 Pelvis: $750 Breast Bilateral: $400 Breast Unilateral: $348 Both Kidneys: $520 Soft Tissue Head and Neck: $686 Thyroid: $707 OB Initial> 14 Weeks: $441 Nuclear Medicine Gastric Emptying: $1,175 Bone/Whole Body: $1156 Thyroid Uptake and Scan: $1466 Hida Scan: $1963 CT Brain with/without Contrast: $2,117 Abdomen and Pelvis with Contrast: $2,483 Abdomen without Contrast: $1,300 Chest without Contrast: $1,175 Cervical Spine without Contrast: $1,406 MRI Lumbar Spine without Contrast: $2,300 Any Joint Lower without Contrast: $2,573 Breast Bilateral with/without Contrast: $2,700 Brain with/without Contrast: $3,094 Cervical without Contrast: $2,214 MRA Brain or Neck without Contrast: $2,025 Brain or Neck with Contrast: $2,362 Vascular Ultrasound Vascular Ultrasound: $600 Carotid: $872 Venous Bilateral: $557 Arterial Bilateral Duplex Upper Ext: $579 Cardiology Echocardiogram Complete: $1,680 Nuclear Stress (Lexiscan): $4,322 Exercise Stress: $903 Transesophageal Echo (TEE): $2,356 EKG: $150 Holter Monitor: $568 Laboratory Charges Amylase: $56 APTT: $49 Basic Metabolic Panel: $70 Bilirubin Total: $39 Blood Culture: $76 BNP: $145 BUN: $36 C Reactive Protein: $66 CBC No Diff: $47 Complete Blood Count: $59 Comprehensive Metabolic Panel: $141 CPK: $56 Depakene (Valproic Acid): $88 Electrolytes Panel 4: $70 Glucose: $34 Glucose Bedside: $35 Hematocrit: $24 Hemoglobin: $23 Hemoglobin Glycosylated (HGB A1C): $55 Hepatic Panel: $88 Iron: $49 Lipid Panel: $111 Magnesium: $56 Occult Blood Stool: $30 Pathology Level 4: $133 Potassium $38 Protime: $30 PSA Total: $77 PSA Cancer Screen: $64 Renal Function Panel: $79 Sedimentation Rate: $33 Thyroid Stimulating Hormone (TSH): $101 Troponin: $100 Urinalysis: $40 Urine Culture: $52 Vitamin D: $77 Venipuncture: $26 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 202 Pomerene Hospital Standard Charges Click here for the 2026 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 Visitor & Patients Online Services Main Campus 981 Wooster Road Millersburg, Ohio 44654 (330) 674-1015 Website Optimized and Designed by Bluefoot Digital Marketing Services Share by: