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If you are hospitalized, you will receive an itemized statement for your hospital room, meals, nursing care, laboratory services and other related services. You will also receive a bill from any physician involved in your care.

Customer service ‚Äčrepresentatives are available Monday- Friday 8 a.m.–4:15 p.m., excluding holidays, to assist you with the financial aspect of your care. You may contact them at 330-438-6321 or 800-900-6321. They can also be emailed at PA@Aultman.com.

You are responsible for payment of your hospital bill. For your convenience, we accept cash, checks, Visa™ & MasterCard™ credit cards.

Financial Counseling is available for patients to obtain an estimate of charges for services and make payment arrangements. You can contact our Financial Counselor at 330-684-4716.

Aultman Orrville Hospital is committed to serve and assist those without medical insurance.

DO YOU KNOW THAT YOU MAY QUALIFY FOR FREE HEALTH CARE SERVICES?

In accordance with the Ohio Revised Code Section 5112.17 we are required to provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of the state of Ohio, are not recipients of Medicaid and whose income is at or below the federal poverty guidelines. This does not apply to physician charges effective September 1, 2009. Please keep in mind when calculating your family size that you include yourself, spouse and all children, natural and adopted, under the age of 18 who live in the home or outside the home. Unfortunately, stepchildren cannot be included.      
       

For services delivered on or after Feb. 28, 2017:

Family Size 2017 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

 
Add $4,160 for each additional person if the family unit has more than eight members.

Financial Assistance Eligibility Criteria 2017 Poverty Guidelines Effective Feb. 28, 2017.

Family Discount Level Medicaid 101% 90% 80% 65% 55% 45% 42% AGB
1 $12,060 $16,394 $12,060 $18,090 $24,120 $30,150 $36,180 $42,210 $48,240
2 $16,240 $22,107 $16,240 $24,360 $32,480 $40,600 $48,720 $56,840 $64,960
3 $20,420 $27,820 $20,420 $30,630 $40,840 $51,050 $61,260 $71,470 $81,680
4 $24,600 $33,534 $24,600 $36,900 $49,200 $61,500 $73,800 $86,100 $98,400
5 $28,780 $39,247 $28,780 $43,170 $57,560 $71,950 $86,340 $100,730 $115,120
6 $32,960 $44,960 $32,960 $49,440 $65,920 $82,400 $98,880 $115,360 $131,840
7 $37,140 $50,687 $37,140 $55,710 $74,280 $92,850 $111,420 $129,990 $148,560
8 $41,320 $56,428 $41,320 $61,980 $82,640 $103,300 $123,960 $144,620 $165,280

Families/households with more than 8 persons, add $4,180 for each additional person.

Federal Poverty Level 100% (HCAP) up to 150% up to 200% up to 250% up to 300% up to 350% up to 400% over 400 %



Financial Assistance Eligibility Criteria 2017 Poverty Guidelines Effective Feb. 28, 2017.

Monthly Income

Family Size Discount Level Medicaid 101% 90% 80% 65% 55% 45% 42% AGB
1 $1,005 $16,394 $12,060 $1,508 $2,010 $2,513 $3,015 $3,518 $4,020
2 $1,353 $22,107 $16,240 $2,030 $2,707 $3,383 $4,060 $4,737 $5,413
3 $1,702 $27,820 $20,420 $2,553 $3,403 $4,254 $5,105 $5,956 $6,807
4 $2,050 $33,534 $24,600 $3,075 $4,100 $5,125 $6,150 $7,175 $8,200
5 $2,398 $39,247 $28,780 $3,598 $4,797 $5,996 $7,195 $8,394 $9,593
6 $2,747 $44,960 $32,960 $4,120 $5,493 $6,867 $8,240 $9,613 $10,987
7 $3,095 $50,867 $37,140 $4,643 $6,190 $7,738 $9,285 $10,833 $12,380
8 $3,443 $56,428 $41,320 $5,165 $6,887 $8,608 $10,330 $12,052 $13,773

 For each additional family member, add $347.

Federal Poverty Level 100% (HCAP) up to 150% up to 200% up to 250% up to 300% up to 350% up to 400% over 400 %
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