Mercy Health - Urbana Hospital

Nonprofit critical access hospital in Urbana, OH.

Verified from the hospital's own policy

Mercy Health - Urbana Hospital likely gives free care to households with a yearly income up to $31,920 for 1 person, $43,280 for 2, $54,640 for 3, $66,000 for 4, $77,360 for 5 or $88,720 for 6. It likely gives a discount to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6.

The hospital makes the final decision.

Discount steps

• 0% to 200% of poverty level, you pay nothing (100% discount)
• 201% to 300% of poverty level, you pay 21% of charges (79% discount)
• 301% to 400% of poverty level, you pay 21% of charges (79% discount)

How to apply

1. Call 1-855-732-0138 and ask for financial assistance.
2. Application form
3. Healthcare Financial Assistance (HFA) Policy, Policy 502 (effective March 1, 2026)
4. Plain language summary
5. Bring proof of income for each household member (3 or 12 months), tax forms with Schedule C if self-employed, benefit letters for unemployment, Social Security, pension or disability, court order for child support, current 30-day statement for each checking or savings account, copy of insurance card if insured.
6. We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.

Residency

Must live in the community the hospital serves. Others need documented extenuating circumstances and emergency or medically necessary care.

Very large bills

Medical or hospital bills left after insurance that are more than 25% of income

Languages

English, Arabic, Cambodian, Cantonese, Dari, French, Gujarati, Haitian Creole, Hindi, Korean, Mandarin, Nepali, Pashto, Portuguese, Punjabi, Russian, Spanish, Swahili, Uzbek, Vietnamese

If you have insurance

Insured patients can also apply for help with deductibles and copays. Keep your insurance. Financial assistance covers bills from this one place only.

What is covered

Covered

Emergency and other medically necessary care at the hospital.

Not covered

Care that is not medically necessary. Mercy Health Medical Group doctor offices and urgent care centers have their own separate policies.

State program in Ohio

Notes

Free care at or below 200% of the poverty level. From 201% to 400%, this hospital takes 79% off the bill (2026 chart, updated each year). Insured patients can get the same sliding discount on what they owe after insurance, such as deductibles, copays and coinsurance. Uninsured patients who do not meet the income limits get an automatic 40% self-pay discount. Some patients get free care without income proof, for example people on food stamps, WIC, school lunch, Medicaid spend-down, or who are homeless. If bills after insurance are more than 25% of income, help may still be available. Mercy may ask you to apply for Medicaid first. An approval covers care for 240 days from the first date of service. The policy does not state a deadline to apply. Assets may be reviewed when little or no income is reported. Patient Financial Services is 1-855-732-0138. The financial assistance web page lists 877-918-5400 for questions. Mail applications to Mercy Health Public Benefits Dept, PO Box 631774, Cincinnati, OH 45263-1774. Ohio residents at or below the poverty line who are not on Medicaid may get basic hospital care free through Ohio's Hospital Care Assurance Program (HCAP). Ohio requests are checked for HCAP first.

Sources

• Free care level

  Individuals with an income level at 200% FPG or below receive free care.

• Discount level

  HFA eligibility is based upon expanded income levels of up to 400% of FPG and is prorated on a sliding scale

• Discount steps

  Mercy Health - Urbana Hospital 100% 79% 79% 40%

• Insured patients

  balances attributed to the patients’ deductible (including co-pay and co-insurance amounts) will require payment based on a sliding scale

• Residency

  Patients who live in the community served by BSMH Healthcare Facilities will be offered HFA.

• Very large bills

  medical or hospital bills after payment by all third parties that exceed 25% of the patient's total Reported Income

• Covered facility

  Mercy Health – Urbana Hospital

• Financial counseling phone

  contacting Bon Secours Mercy Health Patient Financial Services by telephone at 1-855-732-0138

• Documents

  FOR INCOME ASSETS LISTED ABOVE YOU MUST PROVIDE THE FOLLOWING FOR EACH MEMBER OF THE HOUSEHOLD

• Approval period

  Approved applications will be honored for a period of 240 days from the initial date of service

• Assets

  BSMH may evaluate and require documented proof of any assets that are categorized as convertible to cash

• Self pay discount

  BSMH extends an automatic (self-pay) discount to their hospital bills as outlined on Attachment 2.

• Ohio hcap

  BSMH provides, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of Ohio

Last checked. 2026-11-11