Your Community Hospital

1341 Clark Street
Cambridge, OH 43725

CALL TODAY
740.439.8000

Billing Assistance

At Southeastern Med, we understand that the proper medical care can be expensive, especially to those with limited or no health insurance. We will never let the monetary value of our services interfere with giving you the care you need and deserve. Financial aid is available for those who qualify, including patients that are underinsured or without insurance who have hospital bills and outstanding balances.

Billing Assistance

Our financial assistance programs are designed to help patients who meet the financial requirements as issued by the U.S. Department of Health and Human Services. Eligibility determinations are based on Federal Income Guidelines. For further information, please read the Southeastern Med CharityCare and Southeastern Med HCAP Policy and Procedures documents. If you would like to apply for financial assistance, please fill out our Southeastern Med application form.

Please note that you will continue to receive bills until the qualification process has been completed and a decision has been made. Feel free to ask our Resource Counselors for more information by calling 740.439.8140.

2016 HCAP/Charity Guidelines are effective as of January 22, 2016

Hospital Care Assurance & Charity Care Application

 Family Size HCAP (100%) Expanded Medicaid (133%) Charity (150%)  Charity (175%)  Charity (200%)  MCD (200%)
  (100% Discount)  Apply for PE - Medicaid expansion (80% Discount) (60% Discount) AGB via 501 R 52% Discount Apply for PE - Pregnant Women or Children up to age 22
1 $11,880.00 $15,800.40 $17,820.00 $20,790.50 $23,760.00 $23,760.00
2 $16,020.00 $21,306.60 $24,030.00 $28,035.00 $32,040.00 $32,040.00
3 $20,160.00 $26,812.80 $30,240.00 $35,280.00 $40,320.00 $40,320.00
4 $24,300.00 $32,319.00 $36,450.00 $42,525.00 $48,600.00 $48,600.00
5 $28,440.00 $37,825.20 $42,660.00 $49,770.00 $56,880.00 $56,880.00
6 $32,580.00 $43,331.40 $48,870.00 $57,015.00 $65,160.00 $65,160.00
7 $36,730.00 $48,850.90 $55,095.00 $64,277.50 $73,460.00 $73,460.00
8 $40,890.00 $54,383.70 $61,335.00 $71,557.50 $81,780.00 $81,780.00
             

**Add $4,160.00 for each additional family member with more than 8 members**

**Subject to change in 2016**

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