Overview
Columbus Regional Health promises to provide you the best care possible regardless of your ability to
pay. We offer a financial assistance program to qualifying patients that either reduces or fully covers
the out-of-pocket cost of medically necessary services. See the full Financial Assistance Policy for a
detailed list of excluded services, the process for applying, and other information. You must submit a
signed application form and provide the requested documentation in order for your application to be
considered. Instructions can be found on the Financial Assistance Application Form and in the Financial Assistance Policy.
Information concerning the Financial Assistance Policy at Columbus Regional Hospital can be found on the back of each patient statement, on this web site, in the Billing and Financial Assistance Guide found in multiple patient waiting areas around the hospital, by calling Patient Financial Services customer service representatives as 812-376-5315 or 1-800-841-4954 (Hours 8:00am to 4:30 pm, Monday through Friday). This policy is available in both English and Spanish.
Do I Qualify?
Qualification for assistance is based on gross household income and the number of dependents claimed on tax filing for that household, whether filing jointly or individually. (1.501(r)(b)(1)(iii)(A)). Income is compared to the Columbus Regional Health guidelines, which are derived by using the Federal Poverty Guidelines. Income can be up to 350% over the Federal Poverty Guidelines and qualify for assistance. Columbus Regional Health Financial Assistance Policy is in compliance with Federal Regulations 1.501(r). Patients whose gross family income does not exceed 350% of the Federal Poverty Guidelines are eligible for certain levels of financial assistance.
| % Above Poverty Guidelines |
|
0-200% |
201% to 300% |
301% to 350% |
| % of Write Off |
|
100% |
80% |
61% |
| Family Size |
|
|
|
|
| 1 |
|
$14,580.00 to $29,160.00 |
$29,161.00 to $43,740.00 |
$43,741.00 to $51,030.00 |
| 2 |
|
$19,720.00 to $39,440.00 |
$39,441.00 to $59,160.00 |
$59,161.00 to $69,020.00 |
| 3 |
|
$24,860.00 to $49,720.00 |
$49,721.00 to $74,580.00 |
$74,581.00 to $87,010.00 |
| 4 |
|
$30,000.00 to $60,000.00 |
$60,001.00 to $90,000.00 |
$90,001.00 to $105,000.00 |
| 5 |
|
$35,140.00 to $70,280.00 |
$70,281.00 to $105,420.00 |
$105,421.00 to $122,990.00 |
| 6 |
|
$40,280.00 to $80,560.00 |
$80,561.00 to $120,840.00 |
$120,841.00 to $140,980.00 |
| 7 |
|
$45,420.00 to $90,840.00 |
$90,841.00 to $136,260.00 |
$136,261.00 to $158,970.00 |
| 8 |
|
$50,560.00 to $101,120.00 |
$101,121.00 to $151,680.00 |
$151,681.00 to $176,960.00 |
* For each additional person, add $5,140.00
Providers Excluded from Financial Assistance Policy
Care provided by any of the providers or provider groups listed below will not be covered under this Financial Assistance Policy. The patient may contact the provider directly to see if they offer discounts or other financial assistance. This list may not be all inclusive.
Emergency Physicians Inc of Columbus
Columbus Radiology Physicians
South Central Indiana Pathology
Southeastern Indiana Anesthesia Associates
Southern Indiana Orthopedics
Southern Indiana Surgery
Southern Indiana Ear Nose and Throat
Northside Pediatrics
Indiana University Healthcare Associates
Dr. Douglas Wilson- Ophthalmology
Southern Indiana Aesthetic and Plastic Surgery
Columbus Oral and Maxillofacial
Benjamin Podiatry
Columbus Foot and Ankle
Dr. Alice Hartman Gynecology
Columbus Dental Group
Steinmetz Pediatric Dental
Wellspring Pain Solutions
Amounts Generally Billed (AGB) Calculation Summary
Per Treasury Regulations §1.501(r)-5(a)(1), a hospital must limit the amount charged for care provided to any individual who is eligible for assistance under its financial assistance policy to not more than amounts generally billed (AGB) in the case of emergency and other medically necessary care. Columbus Regional Hospital calculates an AGB percentage based on the look-back method and is based on actual claims paid. In accordance with §1.501(r)-5(b)(3)(i), AGB percentage is based on the Medicare fee-for-service and all private health insurers that pay claims to the hospital facility.
The AGB is calculated annually by dividing the sum of the amounts of all of its claims for emergency and other medically necessary care that have been allowed by Medicare and Commercial insurers during a prior 12-month period by the sum of the associated gross charges for those claims. For 2022, the 12-month period utilized was September 1, 2021 – August 31, 2022. The resulting calculation for AGB was 39% and is effective January, 1, 2023 for Columbus Regional Hospital.