CCMH Chargemaster 2019
In most cases, financial arrangements and insurance verification are confirmed with the patient prior to or at hospital registration. As a patient of Carroll County Memorial Hospital, and a partner of our health care team, it is your responsibility to pay for the health care services provided to you.
This facility will bill your primary and secondary insurance carriers or governmental agency directly for the facility fees. Be sure to bring your most current primary and secondary insurance, Medicare or public assistance card with you on the day you receive hospital services.
Please be aware of your insurance plan’s admission policies. You or your physician may have to adhere to certain requirements in order to ensure maximum reimbursement. Failure to obtain pre-authorization, physician referral or a second opinion may greatly reduce or eliminate your benefits.
We bill your insurance carrier shortly after health care services have been rendered. After your insurance company processes our bill, they will send you a summary statement or explanation of benefits (EOB) statement.
The EOB statement is not a bill; it is an itemization to show you how much your insurance company will pay the hospital for services and the portion of the bill that is your responsibility to pay. The hospital, not your insurance carrier, will send you a bill for the portion owed by you. The amount we bill you is due upon receipt. If you are unable to make the payment in full, please contact our business office at (502) 732-3210.
Please be aware that you will receive several individual bills. Your bill from Carroll County Memorial Hospital covers the use of this facility only. It does not include professional fees charged by physicians for laboratory, pathology, medical care, surgery, or anesthesiology. These physicians are independent practitioners and will bill you separately for their services.
Be prepared to pay any co-pay or deductible amounts on the day services are rendered. Patients who do not have insurance coverage or those having non-emergent services are required to pay their co-pay or deductible on the date of service. Please contact our financial counselor 502-732-7141 for information on making payment arrangements.
We realize that at times you may require special financial arrangements. In these instances, please call our financial counselor at (502) 732-7141 prior to your scheduled day or service to discuss alternative methods of payment. Our patient account representatives are available 8 a.m. to 4:30 p.m. Monday through Friday to discuss financial arrangements with you. Carroll County Memorial Hospital accepts cash, cashier’s checks, all major credit cards and personal checks with a valid I.D.
Who is eligible for this financial assistance?
You may qualify for free or discounted emergency or medically necessary care if you meet all of the following criteria:
1. You do not have health insurance, or you have an unpaid balance after your insurance plan has either paid or rejected a claim.
2. You do not qualify for subsidized coverage or government assistance, such as Disproportionate Share Hospital Program, Children’s Health Insurance Program (CHIP), Medicaid, and Medicaid Managed Care Organization.
3. Your family unit’s income is equal to or less than 100 percent of the federal poverty guidelines.
4. Your family unit’s resources (assets) are equal to or less than 100 percent of the Disproportionate Share Hospital guidelines.
5. For additional financial assistance criteria, please refer to the Carroll County Memorial Hospital Charity Care Policy.
What will I be charged for care?
Carroll County Memorial Hospital provides hospital-based emergency and other medically necessary care free of charge to all patients who meet the criteria for the Charity Care Policy. Patients who are eligible for financial assistance will not be charged more than the amounts generally billed to patients with insurance coverage. This includes care at Carroll County Memorial Hospital, Bedford Family Practice and Warsaw Family Practice locations.
How do I apply for assistance?
To apply for financial assistance, you must submit a written application. You will have to provide a copy of your previous three months of income by one of the following documents: bank statements, check stubs or award letter.
You can download and print an application using the following links:
- Carroll County Memorial Hospital Charity Application
- Disproportionate Share Hospital Program (DSH) application
You also can pick up an application at Carroll County Memorial Hospital, Bedford Family Practice or Warsaw Family Practice locations.
When you complete the paper application you can drop it off at one of the locations listed above or mail it to:
Carroll County Memorial Hospital
Attention: Financial Counselor
309 11th Street
Carrollton, KY 41008
How can I learn more about the financial assistance policies?
Download information from one of the links below: