PRE-ADMISSION FORM (Hospital Patients Only)

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Billing Information

We recognize the complexity of the hospital billing process and various payment methods, and will gladly assist you in understanding our billing notices and in setting up payment arrangements. We accept Visa, Master Card, Discover Card and American Express for your convenience.

Wayne HealthCare will bill your insurance and you will receive an Explanation of Benefits (E.O.B.) from your insurance explaining how much was paid on your account. Depending on the type of insurance you have, you may be billed the remaining balance. Questions about a remaining account balance can answered by calling 937.548.1141, Ext. 5770 between 7:00 am and 5:00 pm, Monday through Friday.

You may also obtain a detailed statement of charges upon request. This can be requested by calling Ext. 5770 or 5707 during normal business hours. Patients who need assistance with setting up payments may call Ext. 5707 and a Patient Accounts Representative will schedule a time to meet with the patient at a convenient time. If you meet certain income guidelines, you may be eligible for other programs to assist in paying for your services. You may inquire about these programs by calling Ext. 5707 during normal business hours.

Your account management

Patients are the best advocate for obtaining reimbursement from their insurance company. Here is how you can help to ensure accurate billing and payment:

  • Notify the registration staff at the time of service if your insurance coverage has changed.
  • Always provide your current insurance card(s) so we can verify that the information we have in our system matches the information on your insurance card.
  • Know your plan's benefits and exclusions. Benefit plans differ widely between employer groups and only you, as the insured, know the specific information that your plan covers.
  • Monitor the activity of your insurance company in making payment for services rendered. If you have questions, please call us. Your voice has the greatest impact on claim payment/denial.
  • Respond in a timely manner to your insurance company's request for additional information. Most insurers will withhold payment until this information is received.

Pay Your Bill On-Line 

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Private rooms

There is a higher charge associated with a private room accommodation. Insurance companies will not cover this additional cost, unless it is medically necessary and on the order of your physician.

Patient co-pay responsibility

Patients may be responsible for co-pays specific to the service rendered. Co-pays are commonly associated with emergency room visits, clinic visits, diagnostic testing, therapy services, etc. These payments should be made at the time of service. Our financial counseling staff are available to discuss payment options with you if you are unable to make payment in full at the time of service.

Patient responsible for balance

Wayne HealthCare offers payment programs for account balances, which are the responsibility of the patient. Individuals are required to pay in full within 30 days unless other financial arrangements have been made.

Prompt pay discount

A prompt pay discount will be offered if an uninsured individual chooses to pay the balance within 30 days. Payment can be made by personal check or by an approved credit card - MasterCard, Visa, American Express, Discover - or by electronic payment.

Charity care

Wayne HealthCare has always provided charity care to those who do not qualify for medical assistance. For individuals who qualify, balances may be written off as charity care.

Deposits and co-pays

Deposits and co-pays are to be paid at the time of registration. The cashier will take your deposit or co-pay after registration is completed. The Emergency Room will request co-pays and a $50 deposit on self-pay patients. The deposit requirements are:

Ambulatory Care $300
Cardiopulmonary $250
CT Scans $300
MRI $300
Nuclear Medicine $500
OB Admission $300
Pediatrics $200
Physical Therapy $100
Radiology $100
Sleep Lab $300
Surgical $500
Ultrasound $250

Payment plans

Wayne HealthCare offers payment plans to assist you with paying your bill. Monthly payments are required.

Amount Payment Months
$100 or less $25 4
$101 - $300 $35 9
$301 - $500 $50 10
$501 - $700 $60 12
$701 - $1,000 $95 12
$1,001 - $1,500 $100 16
$1,501 - $2,000 $125 16
$2,000 - $2,500 $160 16
$105 24
$2,501 - $3,000 $180 17
$125 24

 For balances over $3,000, our Financial Counselors can assist you. Contact our counselors to set up your payment plan.

Uncompensated (free) care

Uncompensated (free) care is available for those who qualify for financial assistance. After reviewing the patient's ability to pay (by completing our Hospital Care Assurance Program form), it is determined that the patient's/guarantor's income is within the federal poverty guidelines, financial assistance may be provided.

Medicare and Medicaid

If you are covered by Medicare or Medicaid (Ohio or approved Indiana), we will file your claim for you. If you have a Medicare supplemental policy, upon receipt of payment from Medicare, we will bill your supplemental carrier as well.

Insurance benefits and authorization

Wayne HealthCare will make every effort to verify insurance eligibility and benefits. We will also attempt to obtain authorization in accordance with your insurance company's policies. However, as the insured, you are ultimately responsible for knowing your benefits. Please check with your insurance company before receiving non-emergent services to ensure Wayne HealthCare is contracted and whether or not prior authorization is required.

HMO/PPO insurance and third party indemnity insurance

If Wayne HealthCare is contracted with your insurance company, we will submit a claim for payment in accordance with the managed care contract. You are responsible for any out-of-pocket deductible, co-insurance or co-payment amounts. If Wayne HealthCare is not contracted with your insurance company, we will submit a courtesy bill to your insurance company; however, the patient will be financially responsible for any unpaid balances.

Services offered by area physicians

Our community is fortunate to have a variety of skilled physicians. They will bill you directly for their professional services. Kettering Network Radiologist (Xray and MRI readings), Dr. Kathman (cardiopulmonary readings), Midwest Ultrasound, Sleep Lab and Consultants and Anesthesiologist Inc. will bill you direct.

Premier Health/Greenville Emergency 800.875.0136
Pathology 800.288.8325
Kettering Network Radiologist 800.282.0738
Dr. T. Kathman 937.548.0736
Midwest Ultrasound 800.553.1799
Sleep Care Inc. 614.298.2634
Anesthesiologists 800.237.8970

Wayne HealthCare does bill for:

Wayne Professional LLC, EKG readings, two Internal Medicine physicians, and one surgeon.

Surgeon's Office
Dr. McKellar 937.547.0107
Dr. Dutro 937.547.0107
Dr. Ware 937.547.0107
Western Ohio OBGYN
Dr. Lachiewicz 937.548.5365
Dr. Karr 937.548.5365
Dr. Gould 937.548.5365
Family Practice
Dr. Leahey 937.968.7416
Dr. Pyle 937.968.7416
Dr. Lisanti 937.968.3126
Dr. Idris 937.968.0111
 
Hospitalist 937.548.1141

Physician contracts

Not all employed physicians are under the same contracts as Wayne HealthCare. Contact your insurance company for a list of approved physicians.