Pricing

At TriHealth, we understand that choosing a quality health care provider and having the means to pay for health care services are important to you. Although sifting through information on pricing can seem overwhelming, we hope this information can aid you in making an informed decision about your care.

If You Have Insurance

Determining hospital prices is tricky. Like buying a new car, hospital prices reflect a “sticker” price. Except, this sticker amount is based on three things:

  • The market
  • Insurance and government payments
  • Cost of service

Consider the way that hospitals are reimbursed by government insurers, like Medicare and Medicaid. These insurers pay hospitals a set amount regardless of the price. However, that amount may or may not cover the cost of providing the service. At the same time, commercial insurance companies contract with hospitals to pay a reduced or discounted amount of the charges.

Determining payment

As the patient, your payment is dependent upon your individual insurance plan. Most TriHealth patients carry insurance with one of the following companies.

  • Anthem
  • Humana
  • United
  • Aetna
  • Medical Mutual
  • Healthspan
  • PHCS
  • Cigna
  • Great West

The portion you are responsible to pay for is often called a copayment, deductible or coinsurance.  If you are required by your insurance plan to pay a deductible or percent of allowable charges, the “sticker price” you see is reduced by the amount negotiated by your particular insurance company.

Defining the lingo

Here are a few helpful terms in determining what kind of payment might be required of you as part of your insurance plan.

  • Copayment: A fixed dollar amount listed on your insurance card for a specific type of service, like an emergency room visit, for certain procedures, and for physician office visits.
  • Deductible: Usually a fixed dollar amount that you must spend before the insurance company begins to make payment. The overall hospital price is reduced by the amount negotiated by their insurance company.
  • Coinsurance: Usually, the coinsurance is the amount that the patient must pay in addition to the insurance company payment to the hospital The hospital price is reduced by the amount negotiated (allowed) by their insurance company.

If You Do Not Have Insurance

At TriHealth, we understand that dealing with unexpected medical bills can be difficult. If you are unable to pay all or part of your hospital bill, we can help determine if you are eligible for federal, state and hospital programs, as well as direct you to resources that may help you pay your hospital bill.

You need to do two things to determine if you specifically qualify for TriHealth’s financial assistance program:

Call a Financial Counselor at the Appropriate Number:

  • Good Samaritan Hospital: 513 862 4745
  • Bethesda North Hospital: 513 865 5148
  • Bethesda North Ob/Gyn Clinic: 513 865 1647
  • General assistance: 513 862 4745 or 513 865 5148

Complete This Financial Assistance Form (PDF)

You must complete and return this form to qualify for free care or discounts.

Who qualifies for financial assistance?

TriHealth uses the following guidelines to determine who qualifies for financial assistance.

First, find your family size, and then plot your family's income level. Once you've identified your family size and income level, refer to the numbers at the top of the chart to see how much of a discount you may qualify for. For instance, a family of three with an income greater than $37,061 and less than $55,590 would qualify for a 60 percent discount.

   100% Discount  80% Discount  60% Discount  45% Discount
 Family Size: 1 $0 - $11,170 $11,171 - $22,340 $22,341 - $33,510 $33,511 - $44,680
Family Size: 2 $0 - $15,130 $15,131 - $30,260 $30,261- $45,390 $45,391- $60,520
Family Size: 3 $0 - $19,090 $19,091 - $38,180 $38,181 - $57,270 $57,271 - $76,360
Family Size: 4 $0 - $23,050 $23,051 - $46,100 $46,101 - $69,150 $69,151 - $92,200
Family Size: 5 $0 - $27,010 $27,011 - $54,020 $54,021 - $81,030 $81,031 - $108,040
Family Size: 6 $0 - $30,970 $30,971 - $61,940 $61,941 - $92,910 $92,911 - $123,880
Family Size: 7 $0 - $34,930 $34,931 - $69,860 $69,861 - $104,790 $104,791 - $139,720
Family Size: 8 $0 - $38,890 $38,891 - $77,780 $77,781 - $116,670 $116,671 - $155,560

Frequently Asked Questions

How can I pay this bill?

There are several convenient ways to pay your bills:

  • You can pay cash at our cashier’s offices.
  • You also can pay with credit cards or checks when calling, paying online or mailing in your payment.
  • You can choose a payment plan, which is based on your account balance, or you may qualify for financial assistance. See above for qualifications.

Why isn’t my payment showing up on my statement?

Occasionally, payments may pass in the mail while the statements are being sent out. The issue could also be a different date of service. Please check to make sure the account number and statement match. If you have made a payment, then you can disregard the bill.

Do you offer financial assistance?

Yes, TriHealth does offer financial assistance. See above.

All Ohio Hospitals are required to provide medically necessary care, without charge, to eligible persons. This program is referred to as the HCAP (Health Care Assistance Program). To be eligible, you must:

  • Be a resident of Ohio
  • Not be currently receiving Medicaid benefits
  • Be a person or from a family whose income is at or below the Federal Income Poverty Guidelines

Even if you are not eligible for free care through HCAP, you may still be eligible for a discount through the TriHealth Financial Assistance Program. You may qualify for this program if your income is at or below 400% of the Federal Poverty Guidelines even if you are not a resident of Ohio. See chart above.

Do I have to be an Ohio resident for the HCAP (Health Care Assistance program)?

Yes. You do need to be an Ohio resident, but we also offer charitable discounts based on the information from the application. It is most helpful to fill out the financial assistance application as soon as possible.

What is the status of my Financial Assistance Application?

Each application is personally reviewed, and this process can take up to three weeks. However, you are welcome to call us, 513 569 6117, or email to check the status of your application.

Why are my different dates of service attached to different account numbers?

You are registered each time you visit one of our facilities, and you are given a new account number each time you are registered. This process helps ensure the accuracy of your statement and insurance billing, and increases efficiency in our accounting.

Why don’t you have my insurance (or correct) information?

Insurance information is not carried from one account to another. However, as we strive for accuracy, we encourage you to call, 513 569 6117, or email us with your correct information.

Why am I receiving a bill when I was never at a TriHealth facility?

Physicians send lab specimens to TriHealth labs, which would necessitate a charge. The charge could also be from one of our outpatient centers. You may call a customer service representative at 513 569 6117 for help determining your charges.

Why am I being charged a nursery charge when the baby stayed in the room with me?

Nursery charges cover the nursing staff, supplies needed for the baby, and the actual bed. The process of separating these charges helps to identify the care given to both mother and baby.

Why do I have to set up a payment plan?

By setting up a payment plan, you keep your account current and avoid being transferred to a collection agency. Please note that sending a partial payment doesn’t automatically set you up on a payment plan. We request a formal agreement between the patient and TriHealth. You may speak with a customer service representative about setting up a payment plan by calling 513 569 6117.

Why do I have to make a minimum of $25.00 payment?

To be cost effective, there is set a minimum to keep your account current. Interest is not charged on accounts at this time.

When does my account get sent to a collection agency?

TriHealth’s Patient Accounting Department sends three statements to each patient. A representative will attempt to set up a payment plan by calling after the second statement is sent. If you cannot be reached, or we do not hear from you, then your account may be referred to a collection agency.

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