Frequently Asked Questions about Hospital Charges

What does my health insurance pay?

Insurance companies such as Medicare, Medicaid, worker’s compensation, and commercial insurance companies do not pay charges. Instead, they pay a set price that has been predetermined or negotiated. Every insurance company pays the hospital differently based upon their contract and you will only pay for those out-of-pocket amounts determined by your insurance company and individualized benefit plan such as the deductible, co-insurance, co-pay, etc.

What do these health care terms mean?

• Deductible – is the amount you have to pay for health care services before your insurance company starts to pay. The deductible may not apply to all items and services.
• Co-pay – is a set amount of money that you have to pay for covered health services (for example $25 to see your doctor in the office). This is paid at the time you receive the service such as in a doctor’s office, radiology test, or emergency department visit.
• Co-insurance – is a percentage you pay for covered health care services (for example 20% of the allowed amount). The insurance company will determine the amount they will allow as payment for a certain item or service, where a set percentage of that “allowed amount” will be the patient’s responsibility.
• Depending on the specific health insurance and plan you have selected the deductible, co-pay and co-insurance amounts may vary. Additionally, insurance companies have different networks of hospitals, physicians and other health care providers they have contracts with that could impact the amount you owe out-of-pocket. Contact your insurance company to discuss this specific information.

How much will I have to pay out-of-pocket?

If you have insurance, you will owe any deductible, co-insurance or co-pay determined by your insurance company. If you have reached your out-of-pocket maximum for the year or have secondary insurance, then you may owe nothing. Your financial obligations could differ depending on whether your services are considered covered services by your insurance company. Please contact your insurance company or our financial counselors to understand your financial obligations.

If you do not have insurance our financial counselors can discuss government or financial assistance options according to Premier Health’s financial assistance policy. To speak with a patient financial counselor to receive a patient specific estimate, please contact our price line at (937) 499-7364(937) 499-7364 option 5 or toll-free at (855) 887-7364.(855) 887-7364

How can I get an estimate for a specific procedure?

Premier Health provides estimates to patient who would like to understand their potential out-of-pocket expenses for scheduled services. This is only an estimate and the actual out-of-pocket amount may vary based on when the estimate was run compared with the current status of your benefits, the actual service(s) performed and any complications that may arise. 

For many services, an estimate is provided at the time you schedule your appointment. You may contact a financial counselor for an estimate. 

• Login to MyChart Patient Price Estimator
• Guest Access to MyChart Patient Price Estimator

Will my bill be different than my estimate of charges?

Your actual charges could be more or less than your estimate, based on the specific factors of your care.

Some of these factors include:

• Needing additional testing, medications, services, or procedures during your care
• The procedure planned may not be the procedure performed based on your physician's assessment
• Pre-existing health factors such as obesity, diabetes, smoking history, etc. may impact your medical care
• If you are insured, the type of insurance you have will determine your final bill based on your deductibles, co-insurance, co-pays or out-of-pocket maximum

What other charges will I owe?

In addition to your hospital charges, you may receive bills from other care providers such as fees from your physician, surgeon, anesthesiologist, emergency specialist, pathologist, radiologist or other physician(s) who may help with your care. Please contact those offices directly for questions regarding an estimate or regarding your bill.

What amount do I owe if I do not have insurance?

We encourage uninsured patients to contact a financial counselor in patient financial services at (937) 208-2777 or toll free at (855) 208-2777(855) 208-2777 prior to receiving services at Premier Health. The financial counselor will help determine if you qualify for Medicaid or any other type of financial assistance. For more information, see our billing policies.

How much is my co-pay/co-insurance/deductible?

If you have health insurance and would like to know the amount of any co-insurance, co-payments or deductibles, please contact your health insurance company directly. Your insurance company can also provide you information regarding your current status with your deductible and out-of-pocket maximum limits.

How are charges established for hospital services?

Charges are generally revised each year on January 1 and are subject to change during the year.

Charges reflect many factors, including

• The cost of providing staff, equipment, facilities, medications, and other supplies 24 hours a day 7 days a week as a hospital needs to have everything necessary to cover any and all emergencies
• The amount of time our staff are involved in providing services and care
• Insurance company contracts
• Information provided by the Centers for Medicare and Medicaid Services (the federal agency that manages the Medicare and Medicaid program)

What if the procedure I’m looking for is not part of the online patient estimator? Charges for the most common procedures are provided on this website. If you cannot locate the charge information you are looking for, please call the procedure price line at (937) 499-7364(937) 499-7364 option 5 or toll-free at (855) 887-7364(855) 887-7364. A representative is available to help you Monday through Friday, 8:30 a.m. to 4 p.m.

Where can I get answers to questions about my bills?

Please contact patient financial services at (937) 203-4886(937) 203-4886 or toll-free at (888) 566-4856(888) 566-4856, Monday through Thursday, 8 a.m. to 8 p.m. and Friday, 8 a.m. – 6 p.m. if you have any questions about your bill or if need to set up payment arrangements.