This list of frequently asked questions can help you understand your hospital bill. It is important that you familiarize yourself with your health plan and what it covers. If you have specific questions about your hospital coverage, please contact your health insurance plan.
Plain Language Summary Financial Assistance Policy
Ashtabula County Medical Center is committed to offering financial assistance to people who have health care needs and are not able to pay for care. You may be able to get financial assistance if you are not insured, underinsured, not eligible for a government program, do not qualify for governmental assistance (for example Medicare or Medicaid), or who are approved for Medicaid but the specific medically necessary service is considered non-covered by Medical Assistance. Ashtabula County Medical Center strives to make sure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. This is a summary of the Ashtabula County Medical Center’s Financial Assistance Policy.
Availability of Financial Assistance
You may be able to get financial assistance if you do not have insurance, are underinsured, or if you are unable to pay the out of pocket expenses for services at Ashtabula County Medical Center. Please note that there are certain service exclusions that are not typically eligible for financial assistance, including, but not limited to transplants, cosmetic services and other services. The Ashtabula County Medical Center Charity Care program and Hospital Care Assurance Program excludes Physician, Physician Assistant, Nurse Practitioner or CRNA that might have participated in your care. These are often known as professional fees which are billed independently of the hospital’s services. Examples include, Anesthesiology, Emergency Department, Hospitalists, Surgeons, Radiologists and Pathologists. If you meet our criteria for a free care, we will share that finding with these providers, but they are under no obligation to also provide free care. For services from The Ashtabula Clinic (TAC) please see the TAC Financial Assistance Policy. The Basis for how Ashtabula County Medical Center calculated the amount charges to patients can be found in Appendix A.
Eligibility Requirements
Financial assistance is generally determined by total household income based on Federal Poverty Guidelines. When total household income is less than 200% of FPL, a 100% discount from gross charges will be applied. With regard to balances after insurance payment (underinsured), when the total household income is less than 200% of FPL, a 100% discount from gross charges will be applied.
Federal Poverty Guidelines Chart *Effective as of January 2021
|
Family Size |
100% FPL |
200% FPL |
|
1 |
$12,880 |
$25,760 |
|
2 |
$17,420 |
$34,840 |
|
3 |
$21,960 |
$43,920 |
|
4 |
$26,500 |
$53,000 |
|
5 |
$31,040 |
$62,080 |
|
6 |
$35,580 |
$71,160 |
|
7 |
$40,120 |
$80,240 |
|
8 |
$44,660 |
$89,320 |
|
More than 8 |
Add $4,540 (Per Person) |
|
Eligibility Requirements - Continued
No person eligible for financial assistance under the FAP will be charged more for medically necessary care than amounts generally billed to individuals who have insurance covering. If an individual has sufficient insurance coverage or assets available to pay for care, he/she may be deemed ineligible for financial assistance. Please refer to the full policy for a complete explanation and details.
Where to Find Information
There are many ways to find information about the FAP application process, or get copies of the FAP or FAP application form. To apply for financial assistance you may:
- Download the information online at acmchealth.org
- Request the information in writing by mail or by visiting the Ashtabula County Medical Patient Financial Services office at 2131 Lake Ave Suite 3, Ashtabula Ohio 44004
- Request the information by calling (440) 997-2262 and asking to speak with a Financial Counselor.
Availability of Translations
The Financial Assistance policy, application form, and the plain language summary are offered in English and Spanish. Ashtabula County Medical Center may elect to furnish translation aids, translation guides, or provide assistance through use of qualified bilingual interpreter by request. For information about Ashtabula County Medical Center’s Financial Assistance Program and translation services, please call a representative at (440-997-6219)
How to Apply
The application process involves filling out the financial assistance form and submitting the form along with the supporting documents to Ashtabula County Medical Center for processing. You may also apply in person by visiting the Business Office at the address listed below. Financial assistance applications are to be submitted to the following office:
Ashtabula County Medical Center
Attn: Patient Financial Services
2420 Lake Ave.
Ashtabula, Oh 44004
Uninsured patients have a right to receive an estimate of charges prior to non-emergent services. Please consult with a Financial Counselor at (440) 997–6219 to help you with this request.
Yes. We are a not-for-profit community hospital committed to treating everyone who comes through our doors, regardless of their ability to pay.
The insurance carried by the patient is always primary. The spouse's insurance is always secondary.
According to Ohio state law, the parent whose birth month comes first in the year carries the primary insurance. The other parent's insurance is secondary.
Yes. You are responsible for your medical bills. As a courtesy to you, we bill your insurance. However, if we run into a situation where your insurance company is not paying in a timely manner, we do expect you to intervene and assist with getting them to pay your bill.
We send the bill to your insurance company. We do not send copies of bills to patients unless they specifically ask for a copy. However, we do send notifications to you regarding the status of your claim with your insurance company if you owe a balance.
Anytime you use the following services at our hospital, you may receive a bill from a billing service other than ACMC: emergency department, radiology, laboratory, physician/surgeon, anesthesiology.
Please refer to your Medicare handbook for information regarding co-payments and deductibles. If you have secondary insurance, please share the information with our registration or billing staff. As a courtesy to you, we will bill your secondary insurance for any deductibles or co-payments.
You may Pay Online or drop off payment at:
- ACMC Patient Financial Services Office
- 2131 Lake Ave. Suite 3 | 8 a.m. to 4:30 p.m., Monday through Friday
You may mail your payment to:
Ashtabula County Medical Center
2420 Lake Ave.
Ashtabula, OH 44004
We invite you to visit our business office anytime between 8 a.m. and 4:30 p.m., Monday through Friday at 2131 Lake Ave, Suite 3. Or call us at 440.997.6670.