Patient Pricing

  • Patient Pricing

    Patient Price Information List

    In compliance with state law, Highland District Hospital is providing this price list containing our charges for room and board, emergency department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or under insured patients should consult with our patient financial services and/or billing staff to determine whether they qualify for discounts or financial assistance. These prices are correct as of January 1, 2015.

    Room & Board  (Per Day Charges)

    Room Charge Per Day
    Med/Surg Semi-Private $872.00
    Med/Surg Private $926.00
    Geriatric Psych $1930.00
    OB $872.00
    Nursery $728.00
    Birthing Room


    Swing Bed  $872.00

    Labor and Delivery Charges

    The following list does include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration are not reflected, and will be billed separately by your physician.

    Service Average Charge
    Normal Delivery $5,400.00
    Cesarean Section Delivery $13,355.00
    Amniocentesis $186.00
    Fetal Monitor Per Hour $219.00
    Labor Room Per Hour $238.00

    Emergency Room Charges

    Service Charges
    Level 1 $150.00
    Level 2 $262.00
    Level 3 $410.00
    Level 4 $619.00
    Level 5 $850.00
    Critical Care $699.00

    Operating Room Charges

    Operating Room charges are based on the complexity of the operation. There is an initial charge (includes first 30 minutes and set-up) as well as an additional charge for each 15 minutes while the operation is being performed.

    Service Charges
    Level 1 $1,500.00
    Level 2 $2,350.00
    Level 3  $3,122.00
    Level 4  $3,973.00
    Level 5  $5,000.00

    Rehabilitation Charges

    The following charges reflect the most common services offered by our Physical and Occupational Rehabilitation department. Patients may have additional charges, depending on the services performed.

    Service Charges
    Therapeutic activity $138.00
    Exercise $93.00
    Sensory integration $118.00
    Paraffin bath $101.00
    Laser therapy $70.00

    Pulmonary Therapy Charges

    The following charges reflect the most common services offered by our Cardiopulmonary department. Patients may have additional charges, depending on the services performed.

    Service Charges
    Oxygen per hour $12.00
    Small volume nebulizer, initial $111.00
    Small volume nebulizer, subs $89.00
    Pulse, oximetry, single $57.00

    X-ray and Radiological Charges

    The following charges reflect the hospital's 30 most common x-ray and radiological procedures.

    Service Charges
    Chest x-ray 2 view $240.00
    Chest x-ray 1 view $181.00
    Digital Screening Mammogram $198.00
    Acute abdomen series $320.00
    Lumbar spine 2 or 3 view $320.00
    C-Spine 3-view $226.00
    Ultrasound, OB Complete $557.00
    Ultrasound abdomen limited $434.00
    PET Scan $3561.00
    Ankle 3 view unilateral $216.00
    Dexa Scan $475.00
    Foot 3 view unilateral $261.00
    Hand 3 view unilateral $261.00
    MRI Lumbar $2,197.00
    Knee 1 or 2 view $194.00
    Abdomen 1 view $226.00
    Shoulder 2 view unilateral $205.00
    Dorsal spine 2 view $185.00
    Ultrasound bladder / renal $447.00
    Digital Diagnostic Unilateral Mammogram $149.00
    Wrist 3 view $226.00
    Ultrasound Pelvis $540.00
    MRI Brain w/o contrast $2,197.00
    MRI Lumbar $2197.00
    Ultrasound abdomen complete $629.00
    CT abdomen/pelvis with contrast $2,672.00
    CT head/brain without contrast $1,130.00
    Myocardial perfusion SPECT $2,543.00
    CT stone search $2,136.00
    CT Chest without contrast  $1,130.00

    Laboratory Charges

    The following charges reflect the hospital's 30 most common laboratory procedures.

    Service Charges
    Complete Blood Count (CBC) $42.00
    Basic Metabolic Profile (BMP) $77.00
    Complete Metabolic Profile (CMP) $145.00
    ProTime $42.00
    Urinalysis $62.00
    TSH $113.00
    Lipid Panel $98.00
    Troponin $106.00
    CPK-MB $60.00
    CPK Total $45.00
    Thin Prep PAP $119.00
    Activated PTT $52.00
    Hepatic Panel $91.00
    Urine Culture $62.00
    Path level IV $315.00
    Hemoglobin A1C $78.00
    Urinalysis, no micro $35.00
    B-Type Natriuretic Peptide $200.00
    D-Dimer $78.00
    Hematocrit $40.00
    SGPT $60.00
    SGOT $64.00
    Blood culture $100.00
    Amylase $72.00
    Lipase $67.00
    Hemoglobin $40.00
    Pregnancy, Urine $97.00
    Rapid strep screen $102.00
    Urine drug screen $125.00
    Beta HCG - Quant. $131.00

    Hospital Billing Policies

    For a comprehensive overview of our billing policies, Click Here

    Consumer Information

    Consumers can access a number of government and private Websites, which provide additional information on hospitals' charges and quality. For a complete listing of available online resources, please visit the Consumer's Guide to Quality Health Care in Ohio at

  • Billing & Collection Policy

    Billing & Collection Policy

    Policy/Procedure Title:
    Billing and Collection Policy

    Current Effective Date:

     Approved by:             Board of Governors

    Origination Date: 10/14/15
    Dates Reviewed:
    Dates Revised:      

          Business Office


    Policy #:
    BO 218


    Business Office


    It is the goal of this policy to provide clear and consistent guidelines for conducting billing and collections functions in a manner that promotes compliance, patient satisfaction, and efficiency.  Through the use of billing statements, written correspondence, and phone calls, Highland District Hospital and its designees will make diligent efforts to inform patients of their financial responsibilities and available financial assistance options, as well as follow up with patients regarding outstanding accounts.  Additionally, this policy requires Highland District Hospital to make reasonable efforts to determine a patient’s eligibility for financial assistance under Highland District Hospital’s financial assistance policy before engaging in extraordinary collection actions to obtain payment.


    After our patients have received services, it is the policy of Highland District Hospital to bill patients and applicable payers accurately and in a timely manner.  During this billing and collections process, staff will provide quality customer service and timely follow-up, and all outstanding accounts will be handled in accordance with the IRS and Treasure’s 501(r) final rule under the authority of the Affordable Care Act.


    Extraordinary Collection Actions (ECAs):  A list of collection activities, as defined by the IRS and Treasury, that healthcare organizations may only take against an individual to obtain payment for care after reasonable efforts have been made to determine whether the individual is eligible for financial assistance.  These actions are further defined in Section II of this policy below and include actions such as reporting adverse information to credit bureaus/reporting agencies along with legal/judicial actions such as garnishing wages.

    Financial Assistance Policy (FAP):  A separate policy that describes Highland District Hospital’s financial assistance program including the criteria patients must meet in order to be eligible for financial assistance as well as the process by which individuals may apply for financial assistance.

    Reasonable Efforts:  A certain set of actions a healthcare organization must take to determine whether an individual is eligible for financial assistance under Highland District Hospital’s financial assistance policy.  In general, reasonable efforts may include making presumptive determinations of eligibility for full or partial assistance as well as providing individuals with written and oral notifications about the FAP and application processes.


    1. Billing Practices

    • Insurance Billing
    1. For all insured patients, Highland District Hospital will bill applicable third-party payers (as based on information provided by or verified by the patient) in a timely manner.
    2. If a claim is denied (or is not processed) by a payer due to an error on our behalf, Highland District Hospital will not bill the patient for any amount in excess of what the patient would have owed had the payer paid the claim.
    3. If a claim is denied (or is not processed) by a payer due to factors outside of our organizations control, staff will follow up with the payer and patient as appropriate to facilitate resolution of the claim.  If resolution does not occur after prudent follow-up efforts, Highland District Hospital may bill the patient or take other actions consistent with current regulations and industry standards.
    • Patient Billing
    1. All uninsured patients will be billed directly and timely, and they will receive a statement as part of the organization’s normal billing process.
    2. For insured patients, after claims have been processed by third-party payers, Highland District Hospital will bill patients in a timely fashion for their respective liability amounts as determined by their insurance benefits.
    3. All patients may request an itemized statement for their accounts at any time.
    4. If a patient disputes his or her account and requests documentation regarding the bill, staff members will provide the requested documentation in writing within 10 days (if possible) and will hold the account from being sent to an outside collection agency for 30 days or until the dispute is resolved.
    5. Highland District Hospital or its designees may approve payment plan arrangements for patients who indicate they may have difficulty paying their balance in a single installment.  Payment plans will not exceed 24 months.
      1. The Business Office Manager has the authority to make exceptions to this policy on a case-by-case basis for special circumstances but not to exceed 48 months.
      2. Highland District Hospital is not required to accept patient-initiated payment arrangements and may refer accounts to a collection agency as outlined below if the patient is unwilling to make acceptable payment arrangements or has defaulted on an established payment plan.

    2. Collections Practice

    • In compliance with Ohio State and federal laws, and in accordance with the provisions outlined in this Billing and Collections Policy, Highland District Hospital may engage in collection activities—including extraordinary collection actions (ECAs)—to collect outstanding patient balances.
    1. Patient balances may be referred to a third party for collection at the discretion of Highland District Hospital.  Highland District Hospital will maintain ownership of any debt referred to debt collection agencies, and patient accounts will be referred for collection only with the following caveats:
      1. There is a reasonable basis to believe the patient owes the debt.
      2. All third-party payers have been properly billed, and the remaining debt is the financial responsibility of the patient.  Highland District Hospital shall not bill a patient for any amount that an insurance company is obligated to pay.
      3. Highland District Hospital will not refer accounts for collection while a claim on the account is still pending payer payment.  However, Highland District Hospital may classify certain claims as “denied” if such claims are stuck in “pending” mode for an unreasonable length of time despite efforts to facilitate resolution. 
      4. Highland District Hospital will not refer accounts for collection where the claim was denied due to a Highland District Hospital error.  However, Highland District Hospital may still refer the patient liability portion of such claims for collection if unpaid.
      5. Highland District Hospital will not refer accounts for collection where the patient has initially applied for financial assistance or other Highland District Hospital sponsored program and Highland District Hospital has not yet notified the patient of its determination (provided the patient has complied with the timeline and information requested delineated during the application process).
    • Reasonable Efforts and Extraordinary Collection Actions (ECAs)
    1. Before engaging in ECAs to obtain payment for care, Highland District Hospital or its designees must make certain reasonable efforts to determine whether an individual is eligible for financial assistance under our financial policy:
      1. ECAs may begin only when 120 days have passed since the first post-discharge statement was provided.
      2. However, at least 30 days before initiating ECAs to obtain payment, Highland District Hospital shall do the following:
        1. Provide a plain language summary of the FAP along with the first billing statement.
        2. Provide the individual with a written notice that indicates the availability of financial assistance, lists potential ECAs that may be taken to obtain payment for care, and gives a deadline after which ECAs may be initiated (no sooner than 120 days after the first post-discharge billing statement and 30 days after the written notice)
        3. Attempt to notify the individual orally about the FAP and how he or she may get assistance with the application process
      3. After making reasonable efforts to determine financial assistance eligibility as outlined above, Highland District Hospital (or its authorized business partners) may take any of the following ECAs to obtain payment for care:
        1. Report adverse information to credit reporting agencies and/or credit bureaus
        2. Take legal action including but not limited to:
          1. Garnish wages
          2. Place a lien on property
      4. If a patient has an outstanding balance for previously provided care, Highland District Hospital may engage in the ECA of deferring, denying, or requiring payment before providing additional medically necessary (but non-emergent) care only when the following steps are taken:
        1. Highland District Hospital or its designees provides the patient with an FAP application and a plain language summary of the FAP
        2. Highland District Hospital or its designees provides a written notice indicating the availability of financial assistance.
        3. Highland District Hospital or its designees makes a reasonable effort to orally notify the individual about the financial assistance policy and explain how to receive assistance with the application process.
        4. Highland District Hospital will process any FAP applications for previous care received within the stated deadline listed in the Financial Assistance Policy.
      5. The Patient Financial Advocate is ultimately responsible for determining whether Highland District Hospital and its business partners have made reasonable efforts to determine whether an individual is eligible for financial assistance. 
      6. The Business Office has the final authority for deciding whether the organization may proceed with any of the ECA outlined in this policy.

    3. Financial Assistance

    • All billed patients will have the opportunity to contact Highland District Hospital regarding financial assistance for their accounts, payment plan options, and other applicable programs.
    1. Highland District Hospital’s financial assistance policy is available free of charge.  Request a copy:
      1. In person at the Business Office at 1275 N. High St., Hillsboro, Ohio 45133
      2. By calling the Business Office department at 937-393-6193 or 1-866-393-6100 or mailing a request to 1275 N. High St., Hillsboro, Ohio 45133
      3. Online at
    2. Individuals with questions regarding Highland District Hospital’s financial assistance policy may contact the financial counseling office by phone at 937-840-6512 or in person at 1275 N. High St., Hillsboro, Ohio 45133

    4. Customer Service

    • During the billing and collection process, Highland District Hospital will provide quality customer service by implementing the following guidelines:
    1. Highland District Hospital will enforce a zero tolerance standard for abusive, harassing, offensive, deceptive, or misleading language or conduct by its employees.
    2. Highland District Hospital will maintain a streamlined processed for patient questions and/or disputes, which includes a toll-free phone number patients may call and a prominent business office address to which they may write.  This information will remain listed on all patient bills and collections statements sent.
    3. After receiving a communication from a patient (by phone or in writing), Highland District Hospital staff will return phone calls to patients as promptly as possible (but no more than one business day after the call was received) and will respond to written correspondence within 10 days.
  • Charity Care Application

    Click Here to Download Charity Care Application

  • Financial Assistance Policy

    Policy/Procedure Title:


    Current Effective Date:
    January 25, 2016

     Approved by:
    Pt. Financial Services

    Origination Date: 2.14
    Dates Reviewed: 5.14, 5.15, 9.15
    Dates Revised: 11.15, 1.16

    Financial Counseling


    Policy #:


    Patient Access (Registration and Central Scheduling) and Business Office Staff


    Consistent with its mission to provide high quality healthcare services for the community, Highland District Hospital is committed to providing financial assistance to uninsured and underinsured individuals who are in need of emergency or medically necessary treatment and have a household income within 200% of the Federal Poverty Guidelines (FPG).

    In accordance with the federal Patient Protection and Affordable Care Act (PPACA), patients eligible for financial assistance under this policy will not be charged more than the amount generally billed (AGB) to insured patients for emergency or medically necessary care.


    Financial assistance is provided only when care is deemed medically necessary and after patients have been found to meet all financial criteria.  Highland District Hospital offers both free care and discounted care, depending on individuals’ family size and income. 

    Emergency medical care will be provided by Highland District Hospital for emergency medical conditions to individuals regardless of their eligibility under Highland District Hospital’s financial assistance policy.

    Uninsured patients may be asked or assisted with applying for other external programs (such as Medicaid or insurance through the public marketplace) as appropriate before eligibility under this policy is determined.

    Uninsured patients who are believed to have the financial ability to purchase health insurance may be encouraged to do so to help ensure healthcare accessibility and overall well-being.

    Free care is provided under the provisions of section 5618.14 of the Revised Code, which states that each hospital that receives payment under the provision shall provide, without charge to the individual, basic, medically necessary hospital-level services to the individual who is a resident of Ohio, who is not a recipient of the Medicaid Program and whose income is at or below 100% of the Federal Poverty Guidelines, or are a current recipient of the General Assistance or the Disability Programs as defined in Chapter 5115 of the Revised Code.  This free care is referred to as the Hospital Care Assurance Program (HCAP).  Signs are posted regarding availability of assistance under HCAP in accordance with rules and regulations.

    Uninsured and underinsured patients who do not qualify for free care under HCAP may receive a discount off gross charges for their medically necessary services based on their family income as a percent of the Federal Poverty Guidelines.  These patients are expected to pay their remaining balance for care.                

    When determining patients’ eligibility under this policy, Highland District Hospital does not discriminate based upon race, gender, age, sexual orientation, religious affiliation, social, or immigrant status.


    The following terms are meant to be interpreted as follows within this policy:

    • Charity Care:  Medically necessary services rendered without the expectation of full payment to patients meeting the criteria established by this policy.
    • Medically Necessary:  Hospital services or care rendered both inpatient and outpatient to a patient in order to diagnose, alleviate, correct, cure, or prevent the onset or worsening of conditions that endanger life, cause suffering or pain, cause physical deformity of malfunction, threaten to cause or aggravate a handicap, or result in overall illness or infirmity.
    • Emergency Care:  The care or treatment for an Emergency Medical Condition, as defined by EMTALA.
    • EMTALA:  The Emergency Medical Treatment and Active Labor Act.
    • Uninsured:  Patients with no insurance or third-party assistance to help resolve their financial liability to healthcare providers.
    • Insured:  Individuals who have any governmental or private health insurance.
    • Underinsured:  Insured patients whose households’ income based upon family size is at or below 200% of the Federal Poverty Guidelines for purposes of this policy.
    • HCAP:  The Hospital Care Assurance Program is Ohio’s state-funded, federally required program that compensates hospitals who have a disproportionate share of charity patients that are at or below the Federal Poverty Guidelines as listed by the Department of Health and Human Services.
    • FPG: Federal Poverty Income Guidelines that are published annually by the U.S. Department of Health and Human Services in effect at the date of service for determination of financial assistance under this policy.
    • Gross Charges:  The full amount charged by Highland District Hospital for items and services before any discounts, contractual allowances, or deductions are applied.
    • Residency:  The patient must be living in Ohio voluntarily.  This includes temporary residents, such as students, migrant workers, or illegal aliens, and persons that are temporarily residing with in-state relatives.  Out-of-state patients that are on vacation or any patient who has come to Ohio solely to receive medical care are not considered residents.
    • Family / Household:  Guidelines for a “family” or “household” shall include the patient, the patient’s spouse, and all of the patient’s children, natural or adoptive, under the age of eighteen who live in the home.  If the patient is under the age of eighteen, the “family” shall include the patient, the patient’s natural or adoptive parent(s), and the parent(s)’ children, natural or adoptive under the age of eighteen who live in the home.  In both of the above instances, children are the only family members who must reside in the home to be counted.  Spouses (if still married) are always counted as family members and their income included in the eligibility determination regardless of where they live.
    • Amount Generally Billed (AGB):  The amount generally billed to insured patients for emergent or medically necessary care (determined as described in section (B) of the policy below).


    • Eligibility

    Highland District Hospital will not charge patients who are eligible for financial assistance more for emergency or medically necessary care than the amounts generally billed to insured patients.

    Services eligible for financial assistance include: emergency or urgent care, services deemed medically necessary by Highland District Hospital, and in general, care that is non-elective and needed in order to prevent death or adverse effects to the patient’s health.

    Patients who are uninsured or underinsured and have a household income at or below 100% of the Federal Poverty Guidelines (FPG) (Attachment A) may receive free care (a 100% discount) under Hospital Care Assurance Program (HCAP).

    Patients with annual household incomes between 101% and 200% of the FPG will be eligible for a 57% discount off of gross charges, as illustrated by the table below.

    Financial Assistance Available at Highland District Hospital

    Household Income
    as % of FPG

    Discount off of
    gross charges

    ≤ 100%

    Free Care / HCAP

    101% - 200%


    Determination for financial assistance eligibility will require patients to submit a completed financial assistance application (including all documentation required by the application) and may require appointments or discussion with the hospital’s Patient Financial Advocate.

    •  Determining Discount Amount:

    Once eligibility for financial assistance has been established, Highland District Hospital will not charge patients who are eligible for financial assistance more than the amounts generally billed (AGB) to insured patients for emergency or medically necessary care.

    To calculate the AGB, Highland District Hospital uses the “look-back” method as that term is defined in section 4(b)(2) of the IRS and Treasury’s 501(r) final rule and may be adjusted according to those regulations.

    In this method, Highland District Hospital uses data based on claims sent to Medicare and all private commercial insurers for emergency and medically necessary care over a specified previous year period to determine the percentage of gross charges that is typically allowed by these insurers.

    If the gross charges for an outpatient colonoscopy procedure is $1,000, and the AGB percentage is 43%, any patient eligible for financial assistance under this policy will not be personally responsible for paying more than $430 for an outpatient colonoscopy procedure.

    Because the AGB percentage for services is 43%, and because the minimum amount of assistance available under this policy is a 57% discount off gross charges, no patient eligible for financial assistance will be required to pay an amount in excess of AGB.

    For patients that have health insurance coverage and are eligible for financial assistance, those patients will not personally be financially responsible for paying in the form of deductibles, co-insurance, and co-payments, more than the AGB for the care after all reimbursements by their health insurance plan have been made. 

    •  Applying for Financial Assistance

    Highland District Hospital’s billing statements include a written statement that explains the availability of assistance to individuals with income at or below the FPG as eligible for services without charge under HCAP, as well as financial assistance to qualified individuals up to 200% of FPG.

    To apply for HCAP or hospital financial assistance, patients must submit a complete application (including supporting documents) either in person or by mail.

    Applications can be obtained:

    1. At any of the hospital’s Patient Registration areas
    2. From our Patient Financial Advocate in person or by calling (937) 840-6512
    3. On our website at ---Services ->Patient Services->Financial Assistance Application
    4. By calling our Patient Accounts Department at (877) 879-6613
    5. At the hospital Business Office or by calling (937) 393-6193
    6. Make a request by mail, sending request to Patient Financial Services, 1275 N. High Street, Hillsboro, OH  45133

    Patient or patient representative must complete the application.  An application may be taken from the patient or patient representative by the Patient Financial Advocate or Patient Account Associate if the patient is unable to complete an application. All applications should be signed by the patient or by someone who has a legal right to represent.  No e-signatures are acceptable, including facsimile.  Applications are accepted up to three-years from date of the first follow-up patient responsibility notice sent to a patient per OAC 5160-2-07.17.

    To be considered eligible for financial assistance, patients must cooperate with the hospital to explore alternative means of assistance if necessary, including Medicare and Medicaid.  Patients will be required to provide necessary information and documentation when applying for hospital financial assistance or other private or public payment programs.

    In addition to completing an application, individuals should be prepared to supply the following documents to verify family income (including spouse and both parents of minors):

    1. Pay stubs
    2. Unemployment information
    3. Social Security statement or award letters
    4. Disability or Worker’s Compensation
    5. Alimony
    6. Child support
    7. Pensions or veteran’s benefits
    8. Letter from employer
    9. Income tax returns
    10. Income statement
    11. Accountant income statement for self-employed for 3 months prior
    12. If reporting no family income, information on how patients are currently supporting themselves

    Income information will be based on all applicable household income for either three (3) months prior to the date of service multiplied by four (4), or twelve (12) months prior to the date of service.

    Attestation of income and qualifying information submitted on the application shall be confirmed by signature.

    Applications for assistance under HCAP will be accepted for accounts on or after May 22, 1992, and applications for hospital financial assistance will be accepted for accounts for one year from the date-of-service.

    Applications will expire in ninety (90) days from date-of-service for outpatient services or forty-five (45) days from date-of-service for inpatient services.  Thus a new application is not required for multiple visits that occur during this time period.

    Neither HCAP nor financial assistance may be used in conjunction with any other approved prompt pay discount. 

    HCAP may only be applied to hospital services.  Professional services are excluded.

    Self-pay payments on HCAP approved accounts will be refunded in full. 

    Providing false or inaccurate information may serve to disqualify an applicant from receiving financial assistance from the hospital.

    Patients covered under Medicaid do not qualify for HCAP or hospital financial assistance.  Patients covered under the Disability Assistance or its successor program do qualify for HCAP or hospital financial assistance.

    Individuals who do not have any of the documentation listed above, or who have questions about Highland District Hospital’s financial assistance application, or who would like assistance with completing the application may contact our Patient Financial Advocate either in person at 1275 N. High Street, Hillsboro, Ohio 45133, or over the phone at (937) 840-6512.

    Patient Financial Advocate office hours are Monday through Friday from 8:00 am to 4:30 pm.

    •   Actions in the Event of Non-Payment

    The collections actions Highland District Hospital may take if a financial assistance application and/or payment is not received are described in a separate policy.

    In brief, Highland District Hospital will make certain efforts to provide patients with information about our financial assistance policy before we or our agency representatives take certain actions to collect you bill (these actions may include reporting negative information to credit bureaus; legal actions including but not limited to:  property foreclosure, wage garnishment, lien on property, attaching or seizing a patient’s bank account or any other personal property).

    For more information on the steps Highland District Hospital will take to inform uninsured patients of our financial assistance policy and collection activities we may pursue, please see Highland District Hospital’s Billing and Collections Policy.

    You can request a free copy of this full policy in person at Highland District Hospital, by calling us at (937) 840-6512, or by mailing a request to Highland District Hospital at 1275 N. High Street, Hillsboro, Ohio 45133, or online at

    •   Presumptive Eligibility

    If patients fail to supply sufficient information to support financial assistance eligibility, Highland District Hospital may refer to or rely on external resources and/or other program enrollment resources to determine eligibility when:

    1. Patient is homeless
    2. Patient is eligible for other unfunded state or local assistance programs
    3. Patient is eligible for food stamps or subsidized school lunch programs
    4. Patient is eligible for state-funded prescription medication program
    5. Patient receives free care from a community clinic and is referred to hospital for further treatment

    Highland District Hospital may also use previous financial assistance eligibility determinations as a basis for determining eligibility in the event that the patient does not provide sufficient documentation to support an eligibility determination.  Financial assistance applications on file at Highland District Hospital may be used up to twelve months to screen for potential eligibility for subsequent dates of service.

    All patients presumptively determined to be eligible will be informed of the determination and given a reasonable amount of time to submit an application for further assistance if required. 

    • Eligible Providers

    In addition to care delivered by Highland District Hospital, emergency and medically necessary care delivered by the providers listed below is covered under this financial assistance policy:

    1. Dr. Regina Melink
    2. Janice Morris, NP
    3. Cardiologists’ EKG interpretation(s)

    Care provided by any of the independent providers listed below who provide services at Highland District Hospital will NOT be covered under this policy.  As such, bills received by Highland District Hospital patients for care provided by any of the following providers will NOT be eligible for discounts described in this financial policy.

    1. Hospitalists – TCI Primary Health Partners
    2. Anesthesiologist – Resource Anesthesia
    3. Radiologist – Columbus Radiology 

    Patients concerned about their ability to pay for services or who would like to learn more about financial assistance should contact the Patient Financial Advocate at (937) 840-6512.

    Attachment A

    2016 Federal Poverty Guidelines

    % of FPG =



    Family Unit

    HCAP w/o 100%

    w/o 57%




























    Each add'l