OhioHealth Shelby Hospital

Nonprofit critical access hospital in Shelby, OH.

Verified from the hospital's own policy

OhioHealth Shelby 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 off the patient's share)
• 200.1% to 300% of poverty level, you pay 20% of the patient's share (80% discount)
• 300.1% to 400% of poverty level, you pay 35% of the patient's share (65% discount)

How to apply

1. Call 614-566-1505 and ask for financial assistance.
2. Application form
3. Financial Assistance Policy (FAP), RC-2410.004
4. Plain language summary
5. Bring proof of income for the last 3 or 12 months (such as pay stubs), asset information, monthly expenses, explanation of support if income was $0.
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.

Very large bills

Above 400% of poverty level, a Hardship application may be considered case by case for catastrophic, unusual or extraordinary financial hardship

Languages

English, Arabic, Chinese, French, German, Japanese, Korean, Nepali, Russian, Somali, Spanish, 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 billed by OhioHealth, plus care from OhioHealth-employed doctors at the hospital.

Not covered

Transplant services and elective cosmetic care are excluded. Doctors who are not employed by OhioHealth bill separately and are not covered. Outside labs such as Quest Diagnostics are not covered.

State program in Ohio

Notes

OhioHealth help is a last resort. You may be asked to apply for Medicaid or other programs first. Ohio's Hospital Care Assurance Program (HCAP) is on the same application. The application instructions say care is free at or below the poverty level, while the policy itself gives 100% off up to 200% of the poverty level. If you are told something different, ask which program was used. The application asks about savings, property and monthly expenses. You can apply online in MyChart, by mail to OhioHealth, L-4312, Columbus, OH 43260, or by email to customercenter@OhioHealth.com. The policy does not state a filing deadline. Eligible patients are never charged more than insured patients are generally billed.

Sources

• Free care level

  a 100% discount off of the patient's payment responsibility to patients whose income is at or below 200% of the Federal Poverty Guidelines

• Discount level

  a 65% discount off the patient's payment responsibility to patients whose income is at or below 400% of the Federal Poverty Guidelines.

• Discount steps

  a 80% discount off of the patient's payment responsibility to patients whose income is at or below 300% of the Federal Poverty Guidelines

• Insured patients

  Whether you're uninsured, underinsured or facing financial hardships, our Financial Assistance Program provides

• Very large bills

  consider a Hardship application on a case-by-case basis for patients who otherwise demonstrate that a financial hardship is catastrophic, unusual, or extraordinary.

• What is not covered

  Exclusions to this policy include transplant related services and elective cosmetic services.

• What is covered

  The FAP applies only to services billed by OhioHealth and physician services received by a patient at the Hospital from an OhioHealth-employed physician.

• Documents

  Attach income verification to this application. Income verification may include pay stubs or other documents containing income information

• Languages

  Translated copies of the Financial Assistance Policy, this summary of the policy and the application form are available in Spanish.

• Covered facility

  This policy is in effect for all OhioHealth member hospitals and employed physician practices

• Financial counseling phone

  Shelby Hospital 614-566-1505

• Covered facility listed

  OhioHealth Facility Where to call ... Shelby Hospital 614-566-1505

Last checked. 2026-11-11