Departments & Services

Pre-Registration

Please use the following form to Pre-Register for your tests and lab work at East Liverpool City Hospital. Please submit your pre-registration at least 24 hours prior to any scheduled procedure date (this does not pertain to emergency room visits). Pre-registrations submitted closer to the procedure date may not be processed in time for your procedure. Before you can pre-register, you must know the following details:

• Who is your doctor ordering these tests?
• What is your diagnosis from your doctor?
• What tests did your doctor recommend?

If you do not know the answer to these questions, please call 330-385-7200 and ask for our helpful Pre-Registration staff.

Online Patient Pre-Registration Form A field with a red asterisk (*) is a required field First Name: *  Middle Initial: Last Name: *  Patient Address: *  City: *  State: Choose ------------- OH WV PA *  Zip: *  Email Address: *   Home Phone Number: *  Work Phone Number: Date of Birth: * (MM/DD/YYYY)   Primary Insurance Company: *  Primary Insurance Address: *  Policy Number: *  Group Number: *  Note - if you do not have a group number, enter "N/A" and leave a note in the comment field below.   Secondary Insurance Company: Secondary Insurance Address: Policy Number: Group Number:   Ordering Doctor: *  All Applicable Diagnoses: Include all diagnoses given by your doctor. Separate multiple details by a slash ( / ). *    All Tests: Include all tests requested by your doctor. Separate multiple details by a slash ( / ). *  Date of test: *    Question or Comments:   Please enter the code into the field: Please carefully enter the code in this black box into the field below it. It must be an exact match. If you DO NOT enter this information correctly, we may not receive your request!   *

 

Scheduling

Out-patient and non-emergency inpatient procedures must be scheduled through Central Scheduling.
Central Scheduling hours of operation are Monday through Friday 9 a.m. to 4:30 p.m. Outpatient scheduling is not available on Saturdays, Sundays or holidays.

Call 330- 386-2020.

Billing Office

The hospital Business Office will bill your insurance carrier for charges relating to your hospital stay. You or family members need to provide our registration clerks with your insurance information upon admission.

Your payments for charges not covered by insurance, Medicaid or Medicare may be mailed to the hospital or paid at the cashier’s desk on the first floor between the hours of 8:30 a.m. and 3:45 p.m. Monday through Thursday, and 8:30 a.m. to 3:30 on Friday.

Your hospital stay could result in multiple charges and statements from various billing sources.

A hospital bill is an itemized statement of charges for room and board, medications, treatments and services rendered; for example, emergency services, therapy, X-rays, blood tests and EKG testing.

Physician fees are billed separately from hospital services. In addition to a bill from your admitting physician, physicians may charge fees for anesthesiology, radiology, pathology, emergency services and specialty consultation.

Pre-authorization for Insurance
Please be advised that many insurance carriers require pre-authorization for hospital admission, tests and procedures other than those deemed emergencies.

If you were admitted on an emergency basis, or for some other reason did not obtain pre-authorization, call your insurance carrier immediately. Failure to obtain necessary pre-authorization may result in you personally being billed for charges disallowed by your insurance carrier. If you need assistance in obtaining pre-authorization, call the hospital Business Office by dialing extension 2145 on your room telephone.

If you have a problem concerning billing after you are discharged, call the Customer Service Department at 330-386-2057 from 8 a.m. to 4:30 p.m., Monday through Friday.

Free Care Information
If your income is not above the poverty guidelines, or you are a Disability Assistance recipient, you may be eligible for free care. Call our Customer Service Department at 330-386-2057 for help.

HIM

Formerly known as Medical Records, the Health Information Management Department (HIM) maintains patient medical records.

To get a copy of your ELCH medical record, you must sign an authorization form from the HIM Department. Please allow one week for the records to be copied.

You may also write a letter authorizing East Liverpool City Hospital to release a copy of your records. In the letter, you must state the patient's name, date of birth, social security number and date(s) of service. You must sign and date the letter and specify the information to be disclosed. The letter should also state the name(s) of the person (s) to whom the information may be released by the HIM Department. The letter must be signed by the patient on whom the medical record is maintained, or by a person lawfully authorized to act on the patient's behalf.  The letter of request must be dated.

There is a retrieval fee and a copying charge.

Only the patient can release his/her records. However, if you have the power of attorney or are the executor of a patient's estate, you may submit a request in writing along with a copy of the legal document stating your role.

Advance Directives and Other Bioethics Decisions

Upon admission to East Liverpool City Hospital, you or your family member will be asked if you have made an advance directive. Advance directives are legally valid, written documents to ensure that a person’s wishes regarding medical treatment – especially the use of life-sustaining treatment – are respected should they become unable to make and communicate these wishes themselves. Living wills and durable powers of attorney for healthcare are two types of advance directives, which are well-defined and recognized under Ohio law.

Living Wills

As defined by Ohio law, a living will:

• becomes effective only when the person is permanently unconscious or terminally ill and unable to communicate;
• states whether or not a person wishes life-sustaining technology to be used to prolong his or her existence;
• states whether or not artificial feeding and hydration (water) are to be withheld;
• grants physicians authority to follow the instructions;
• can be revoked or changed by the patient at any time, either in writing or orally;
• gives information about anatomical gifts.

Durable Power of Attorney for Healthcare and
Durable Power of Attorney for Psychiatric Healthcare
Under another type of advance directive, call durable power of attorney for healthcare, a person designates an individual to make health care decisions should the person become unable to make these decisions him- or herself. This attorney-in-fact could, for example, give or withhold consent to perform surgery or other procedures, select or dismiss physicians, order transfer to another medical facility, or approve a “comfort measures only” order. The document designating health care power of attorney can incorporate aspects of a living will by including specific statements of the person’s wishes concerning the use of, for example, ventilators, kidney dialysis, blood transfusions, artificial feeding and hydration.

The durable power of attorney for psychiatric healthcare can name a person to make healthcare decisions and can designate medication wishes during a psychiatric crisis.

How to make an advance directive
Copies of forms to make your own living will or durable power of attorney for healthcare are available from the hospital’s Corporate Responsibility Officer, chaplain or a social worker. Those who have made our advance directives should give copies to their hospital, physician, family members, trusted friends and their attorney. Equally important, they should discuss their beliefs concerning dying and the use of life-support technology with those closest to them so there can be no doubt as to their wishes. ELCH will keep a copy of your advance directive on file as a permanent part of your medical record. It is a good idea, however, to make arrangements that, should something happen to you, copies of your advance directive are given as soon as possible to ambulance workers, emergency room personnel and your physician.

Comfort Care
When a patient’s heart or breathing stops, it is hospital policy and common medical practice to use cardiopulmonary resuscitation (CPR) to attempt to save the patient’s life. CPR usually involves airway resuscitation and chest compressions. Advanced CPR may involve electric shock, opening the airway by inserting a tube, injection of medications to restart the heart and, in extreme cases, open heart massage.

Patients wishing to receive all available resuscitation measures are said to have a “full code” status. ELCH recognizes that not all patients wish to be subjected to resuscitation measure. In accord with Ohio law, a person wishing an alternative code status could choose either “DNR Comfort Care Arrest (DNRCC-Arrest)” or “DNR Comfort Care (DNRCC).” Your nurse, the hospital chaplain, a social worker or a member of the bioethics consultation team can help you decide if you desire to have a code status related to the withholding of resuscitation measures and which is appropriate for you.

Comfort care code statuses are recognized as being medically and ethically appropriate in circumstances such as when a patient has a terminal illness. Competent patients have the right to request a comfort care code status for themselves, or specify such a desire in an advance directive.

Patient Right to Decide
Adult patients who are mentally competent have the right to refuse or accept any medical treatment, including life-sustaining treatment. In the case of minors under the age of 18 (excepting those legally emancipated), the wishes of parents or legal guardians will be followed unless there are documented extenuating circumstances. In the case of adult patients who have made advance directives, their wishes as thus communicated will be followed should they lose the capacity to make their own decisions. In the case of adult patients who have not made advance directives, health care decisions are to be made by a surrogate (a guardian, spouse or near relative) if they become incapacitated.

Hospital Rights and Policy
It is the policy of East Liverpool City Hospital to provide quality medical care to its patients in conformity with traditional and current ethical and medical standards, with the objective of sustaining life, preserving health and easing pain and suffering. The hospital strives to preserve patient dignity at all times and respects the legally defined rights of patients and their families to participate in the bioethical decision-making process.

Physician Rights and Responsibilities
A physician may decline to participate in the limitation or withdrawal of treatment from a patient. However, no physician may withdraw from providing care for that patient until another physician has agreed to accept the patient. It is the physician’s responsibility to inform a patient and/or the family about therapeutic options and to thoroughly discuss those options so that an informed decision may be made.

Bioethics Issues
East Liverpool City Hospital maintains an active Bioethics Committee. Should you have any questions regarding medical-ethical concerns, please do not hesitate to request a meeting with a member of the Bioethics Consultation Team. Simply asking your nurse or nurse supervisor for such a meeting can do this.

Organ and Tissue Donation
Ohio law requires that all hospitals that receive Medicare or Medicaid funding have a procedure in place to offer organ donation as an option to families of potential donors. East Liverpool City Hospital provides the option to consider such a donation. For every potential donor, the patient’s family may be approached, at or near the time of death, concerning the possibility of organ and tissue donation. Staff professionals, who are specially trained to identify potential donors will make such a request and work with families through the process. If you would like more information, your nurse will help you contact one of these professionals.

HCAP Application Download

 

Download the HCAP application in .PDF format. Adobe Acrobat Reader required.

 

Insurance

Insurances contracting with ELCH as of 10/09/09
If you do not see your insurance company listed here, feel free to contact our business office to see if they have recently contracted with us for medical services.

ACS-FLORA Health Network
Advantra-Medicare HMO
Affordable Health Care Concepts (First Health Group Corp.)
Anthem Blue Cross/Blue Shield
Assurecare
Aultcare Service Center
Blue Cross/Blue Shield Association -- PPO in a Suitcase Product
Beech Street Corporation
Beyond Benefits - formerly Health Star (also now includes Preferred Health Network)
Care Source - Ohio Medicaid HMO
Central Benefits Mutual
Choicecare Network
Cigna Healthcare
Columbiana Coordinated Health (Quantum Health)
Creative Health Plans
Emerald Health Network
Galaxy Health Network
Great-West Healthcare
Health Assurance
Health Coalition Partners, LLC.
The Health Plan (covers only West Virginia Medicaid enrollees)
Mainstay
Medical Mutual
Megellan Behavioral Health Services
MHNet (Mental Health services only)
Mountaineer HBPA Benevolent Trust
Multi-Plan
Ohio Health Choice
Ohio Preferred Network Partners
One Health Plan
Partners
Primary Health Services
Primenet
Private Healthcare Systems, Inc. (PHCS)
UMWA Health and Welfare Funds
United Healthcare
Unison - PA Medicaid HMO
Unison - Ohio Medicaid HMO
Value Behavioral Health

Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The terms of this Notice of Privacy Practices apply to East Liverpool City Hospital operating as a clinically integrated health care arrangement composed of the hospital, physicians, and other licensed professionals seeing and treating patients. This notice also applies to any member of a volunteer group we allow to help you while you are in the hospital. The members of this clinically integrated health care arrangement work and practice at the main hospital (425 West Fifth Street, East Liverpool, OH 43920) and a satellite Rehabilitation Department (15655 SR 170, East Liverpool, OH 43920). All of the entities and persons listed will share personal health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law.

We are required by law to maintain the privacy of our patients' personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at a registration desk or a copy may be obtained by mailing a request to the hospital’s Corporate Responsibility Officer, 425 West Fifth Street, East Liverpool, OH 43920.

The Corporate Responsibility Officer serves as the hospital’s Privacy Officer.

USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION

Your Authorization.
Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.

Uses and Disclosures for Treatment.
We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your personal health information to that home health care agency so that a plan of care can be prepared for you.

Uses and Disclosures for Payment.
We will make uses and disclosures of your personal health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.

Uses and Disclosures for Health Care Operations.
We will use anddisclose your personal health information as necessary, and as permitted by law, for our health care operations, which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your personal health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your personal health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.

Our Facility Directory.
We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may also be provided to members of the clergy. You have the right during registration to have your information excluded from this directory and also to restrict what information is provided and/or to whom.

Family and Friends Involved In Your Care.
With your approval, we may from time to time disclose your personal health information to family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Business Associates.
Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain of your personal health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Fundraising. We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out" of receiving fundraising materials/communications and may do so by sending your name and address to the hospital’s Corporate Responsibility Officer, 425 West Fifth Street, East Liverpool, OH 43920, together with a statement that you do not wish to receive fundraising materials or communications from us.

Appointments and Services.
We may contact you to provide appointment reminders or test results. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You must request such confidential communication in writing and send your request to the hospital’s Corporate Responsibility Officer, 425 West Fifth Street, East Liverpool, OH 43920. Such requests will be limited to a specific period of time or episode of care.

Health Products and Services.
We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.

Research.
In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a researcher may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained your privacy will be protected by strict confidentiality requirements applied by a privacy board, which oversees the research, or by representations of the researchers that limit their use and disclosure of patient information.

Other uses and Disclosures.
We are permitted or required by law to make certain other uses and disclosures of your personal health information without authorization.

• We may release your personal health information for any purpose required by law;
• We may release your personal health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
• We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
• We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
• We may release your personal health information to your employer when we have provided health care to you at the request of your employer;
• We may release your personal health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
• We may release your personal health information if required to do so by a subpoena issued by a court or administrative tribunal;
• We may release your personal health information to law enforcement officials as required by law to report wounds and injuries and crimes;
• We may release your personal health information to coroners and/or funeral directors consistent with law;
• We may release your personal health information if necessary to arrange an organ or tissue donation from you or a transplant for you;
• We may release your personal health information in limited instances if we suspect a serious threat to health or safety;
• We may release your personal health information if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities; and
• We may release your personal health information to workers' compensation agencies and/or your employer if necessary for your workers' compensation benefit determination.

Ohio Statutory Law/Case Law.
In any instance that the statutory law or case law of the State of Ohio mandates a stricter standard than federal law regarding the privacy of your personal health information, the state law will be followed. Mental health records and records about HIV/AIDS are examples of personal health information addressed in state law.

RIGHTS THAT YOU HAVE

Access to Your Personal Health Information.
You have the right to receive a copy and/or inspect much of the personal health information that we retain on your behalf. All requests for copies must be made in writing and signed by you or your representative. Patients requesting copies of their personal health information for their own use will be charged $1.00 per page for the first 10 pages, $.50 for pages 11 to 50, and $.20 for pages 51 and higher. Attorneys and other parties requesting copies of your personal health information are subject to other charges. We will also charge for postage if you request a mailed copy. Discharge summaries will be provided free of charge. You may obtain an authorization form used to request copies from the hospital's Health Information Management Department.

Amendments to Your Personal Health Information.
You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from the Director of Health Information Management, 425 West Fifth Street, East Liverpool, OH 43920.

Accounting for Disclosures of Your Personal Health Information.
You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. An accounting does not include disclosures made to carry out treatment, payment, and health care operations; to yourself or individuals involved in your care; pursuant to an authorization; for our facility directory; for national security or intelligence purposes; to certain disclosures to correctional institutions or law enforcement officials; or prior to April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the hospital’s Corporate Responsibility Officer. The first accounting in any 12-month period is free; you will be charged a fee of $35.00 for each subsequent accounting you request within the same 12-month period.

Restrictions on Use and Disclosure of Your Personal Health Information.
You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. A request for restriction(s) must be made in writing and signed by you or your representative. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate. No restrictions on disclosure of information to payors will be granted. If we grant a restriction on disclosure of information to a specific person, you will also be required to “opt-out” of the facility directory. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by providing such termination notice to the Health Information Management Department, 425 West Fifth Street, East Liverpool, OH 43920.

Complaints.
If you believe your privacy rights have been violated, you can file a complaint by asking to speak to one of the hospital’s patient representatives. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.


FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact the hospital’s Corporate Responsibility Officer, 425 West Fifth Street, East Liverpool, OH 43920, (330) 385-2954.

As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.

EFFECTIVE DATE
This Notice of Privacy Practices is effective April 14, 2003.

YOU WILL BE ASKED TO ACKNOWLEDGE THAT YOU RECEIVED THIS NOTICE OF PRIVACY PRACTICES.

Patient Bill of Rights

The basic rights of human beings for independence of expressions, decision and action and concern for personal dignity and human relationships are always of great importance. During sickness, however, the presence or absence of these rights becomes a vital, deciding factor in survival and recovery. Thus, it becomes a prime responsibility for hospitals to endeavor to assure that these rights are preserved for their patients.

In providing care, hospitals have the right to expect behavior on the part of the patient and their relatives and friends, which, considering the nature of their illness, is reasonable and responsible.

This statement does not presume to be all-inclusive. It is intended to convey the East Liverpool City Hospital’s concerns about the relationship between hospital and patient and to emphasize the need for the observance of the rights and responsibilities of patients.

The following basic rights and responsibilities of patients are considered reasonably applicable to all hospitals.

Right of Access to Care

Individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, color, creed, age, sexual preference, sex. Marital status, religious belief, national origin, handicap, whether all or part of one’s income derives from any public assistance program, or ability to pay.

Right to Privacy and Confidentiality

The patient has the right to considerate care and to respect of personal dignity. The patient has the right to as much privacy and confidentiality of records as possible in accordance with the needs of care and treatment.

Right to Credentials

The patient has the right to know the identity and the professional status of the individuals involved in his/her care and any professional relationships between those individuals.

Right to Information and Consent

The patient has the right to know his/her diagnosis, what the diagnosis means, methods of treatment and possible outcomes. The patient has the right to participate in decision s involving his/her care and provide or withhold informed consent for any treatment or diagnostic testing. If the patient is not in a condition to understand or participate in decision-making, the information shall be given to the patient’s authorized representative.

Right to Itemized Bill

The patient has the right to request and receive an itemized statement for services.

Right to Respect and Dignity

The patient has the right to considerate, respectful care at all times and under all circumstances, with recognition of his personal dignity. Hospital employees shall consider the patient’s personal values and beliefs when providing care.

Right to Personal Safety and Security

Each patient has the right to a secure environment while a patient in the hospital. With this goal in mind, a security guard is stationed within the hospital 24 hours a day.

Right to Protective Services

All patients have the right to access protective services or shall be referred to the Social Services and Counseling Department in order that a social worker or therapist might make a referral to adult or children’s services.

Patient Safety and Risk Management

Ensuring patient safety and reducing risk is a goal of all employees. The hospital has an active Safety/Risk Management Committee which meets on a regular basis and employes a professional risk manager. The hospital also has a formal performance related monitoring system to evaluate safety and environment of care issues.

Right to Pain Management

All patients have a right to have their pain assessed and managed properly.

Facts about pain and medication:

• Pain medications, when given with supervision, are safe and effective. Strong pain medications are rarely addictive when given in this manner.
• Your physician may prescribe medications that can help relieve any side effects.
• It is understood that pain or discomfort may be intensified after operative procedures, certain activity levels and during the healing process.
• Taking pain medication prior to walking or exercising can make that activity more tolerable and, perhaps, speed your recovery.
• The pain management plan of care is based on your doctor’s orders and your medical condition.

Patient Complaint & Grievance Resolution Process

East Liverpool City Hospital strives to provide quality medical care and caring service. However, in the event of a patient care problem or complaint, a complaint and grievance resolution process is available to patients. Such matters should first be addressed to your nurse or other direct care provider. If the matter is not resolved in a reasonable time, you may ask to speak to a department manager or patient representative. A record will be made of your complaint for investigation by the party responsible for the service area. A hospital committee then reviews the complaint response to ensure that actions are adequate. Generally, you will be contacted by the person investigating your complaint. It is also customary for you to receive a follow-up letter about the assessment of your complaint.

Patients may also file a complaint with the Ohio Department of Health by calling 1-800-342-0553 or e-mailing HCComplaints@odh.ohio.gov. Medicare beneficiaries may contact KePro, a Quality Improvement Organization, by calling 1-800-589-7337.

Patients who voice complaints will not be subject to discrimination, reprisal or interruption of care.

Patient Price Information

East Liverpool City Hospital maintains billing policies and procedures intended to safeguard the financial well-being of the hospital while taking into account the economic realities of its surrounding community. Efforts are made to bill in full compliance with regulations or guidelines of federal, state, and commercial payors. When balance billing is permissible, patient accounts are subject to progressive collection efforts including the use of collection agencies. However, patients who supply evidence of financial hardship may qualify for payment plans, partial forgiveness, or full forgiveness of account balances. The hospital does not apply interest to account balances.

More information about East Liverpool City Hospital's billing policies is available by contacting the business office at 330-386-2047 or 330-386-2901. Questions may also be submitted by e-mail using the "Contact Us" option on the hospital's website.

Consumers can access a number of government and private Websites, which provide additional information on hospitals' charges and quality. For a complete listing of available online resources, please visit the Consumer's Guide to Quality Health Care in Ohio at http://www.ohanet.org/portal

Patient Price Information List

ROOM RATES:			LABORATORY:
Private Med/Surg	$395.00/Day		Activated Partial Thromboplastin Time (APTT)	$32.30
Semi Private Med/Surg	$385.00/Day		Amylase	$28.60
Intensive Care	$955.00/Day		Basic Metabolic Panel (BMP)	$84.80
Intermediate Unit (Telemetry)	$610.00/Day		Blood Cultures	$45.30
Skilled Nursing Unit - Semi Private	$225.00/Day		Blood Urea Nitrogen (BUN)	$28.60
Skilled Nursing Unit - Private	$240.00/Day		Creative Kinase, Total (CK or CPK)	$28.60
Obstetrics Room	$395.00/Day		Creative Kinase, Myocardium (CK-MB)	$51.00
Pediatrics Semi-Private	$376.00/Day		Creatinine	$28.60
Pediatrics - Private	$390.00/Day		Complete Blood Count (CBC)	$39.60
Nursery Border	$305.00/Day		Complete Blood Count w/o differential (CBC no diff)	$28.60
Nursery Newborn	$295.00/Day		Comprehensive Metabolic Panel (CMP)	$93.60
			Complete Urinalysis (UA) Referral	$28.60
			Differential Manual (MDIFF) Services	$17.20
RADIOLOGY:			Erythrocyte Sedimentation Rate (ESR)	$22.90
Skull	$129.00		Glycosylated Hemoglobin (AIC)	$45.30
Chest	$104.00		Gram Stain	$18.20
Ribs	$111.00		Hemoglobin (HGB)	$17.20
Abdomen Series	$136.00		Hematocrit (HCT)	$17.20
Pelvis	$83.00		Hepatic Function Panel	$52.00
Cervical Spine	$150.00		Lactate Dehydrogenase (LDH)	$28.60
Thoracic Spine	$146.00		Lipase	$32.30
Lumbar Spine	$208.00		Lipid Panel	$112.90
Finger	$62.00		Magnesium (MG)	$41.10
Hand	$76.00		Phosphorus (Phos)	$33.80
Wrist	$74.00		Pregnancy Test, Qualitative	$56.70
Elbow	$114.00		Prothrombin Time (PT)	$28.60
Forearm	$75.00		Thyroid Stimulating Hormone (TSH)	$82.70
Shoulder	$78.00		Troponin I	$43.70
Hip Complete	$98.00		Urine Culture	$45.30
Knee	$100.00		Venipuncture Charge	$14.10font>
Lower Leg	$73.00
Ankle	$80.00		Charge does not include fee for services of pathologist
Foot	$80.00		Please contact MD Billing at 304-387-3000 to obtain these charges
Toe(s)	$95.00
Sinus	$129.00
Upper GI Series	$285.00
Intravenous Pyelogram	$271.00
Mammogram Screening	$78.00
Mammogram - Diagnostic	$170.00		Emergency Room:
CT Sinus	$542.00		Emergency Level I	$78.00
CT Head	$695.00		Emergency Level II	$115.00
CT Chest	$738.00		Emergency Level III	$208.00
CT Abdomen	$731.00		Emergency Level IV	$390.00
CT Pelvis	$731.00		Emergency Level V	$572.00
			Cast Room	$78.00
Charge does not include fee for services of radiologist			Additional charges for select surgical procedures	$26.00-$364.00
Please contact ELCH's Medical Imaging Department at 330-386-2026 for further information			Charge does not include fee for services of emergency room physician. Please contact Tri-State Emergency Physicians at 877-868-2059 ext. 266 to obtain these charges.
Surgical Room Time:			Common Speech and Hearing Services:
Per 30 Minute Increment	$1,236.00		Assessment Aphasia With Interpretatin and Report	$85.50
Special Procedure Room per 30 minitures	$1030.00		Cognitive Skills Development Each 15 minutes	$60.00
Recovery Room	$618.00		Dysphagia Evaluation	$162.00
			Evaluation up to 30 minutes	$162.00
Additional Charges for Non-Routine Supplies			Evaluation over 30 minutes	$182.00
			Motion Fluroscopy/Swallow	$180.00
			Neuro Behavioral Exam with Report	$105.00
			Swallow Treatment 30 minutes	$104.00
			Treatment Individual-less than 30 minutes	$75.00
Delivery Room:			Treatment Individual-more than 30 minutes	$130.00
Labor Room Charge	$800.00		Typanometry	$35.00
Vaginal Delivery Charge	$700.00
C-Section Charge	$1200.00
Recovery Room Charge	$600.00
Observation Room per Hour	$15.00		Respiratory Therapy:
			Aerosol Treatment	$40.00
			Bronchodilator Challenge	$200.00
			IPPB Treatment, Initial	$50.00
Common Physical Therapy Services:			IPPB Treatment, sebsequent	$40.00
Debridement with Tools	$101.00		Oxygen	$56.00/Day
Electro Stimulation - Unattended	$48.00		Postural Drainage	$45.00
Evaluation - Initial	$117.00		Ventilation MGT, 1st Day	$275.00
Gait Training - 15 minutes	$53.00		Ventilation MGT, Subsequent Day	$245.00/Day
Group Treatment I	$53.00
Iontophoresis - 15 minutes	$64.00
Jobst Pump - 1 hour	$52.00
Light Therapy	$40.00
Manual Therapy Techniques - 15 minutes	$48.00		East Liverpool City Hospital maintains billing policies and procedures intended
Massage - 15 minutes	$48.00		to safeguard the financial well-being of the hospital while taking into account the economic realities
Neuromuscular Reeducation, Movement, Balance - 15 minutes	$53.00		of its surrounding community. Efforts are made to bill in full
Physical Therapy Reevaluation	$75.00		compliance with the regulations or guidelines of federal, state, and commercial payers.
Therapeutic Exercise 1 more area 15 minutes	$53.00		When balance billing is permissible, patient accounts are subject to progressive collection efforts including
Therapeutic Activities 15 minutes	$43.00		the use of collection agencies. However, patients who supply evidence of financial hardship
Ultrasound	$46.00		may qualify for payment plans, partial forgiveness, or full forgiveness of account balances.
Whirlpool/Fluido Therapy	$48.00		The hospital does not apply interest to account balances.
			More information about East Liverpool City Hospital's billing policies is available by
Common Occupational Therapy Services:			contacting the Business Office at 330-386-2901 or 330-386-2047. Questions may also
Cognitive Skills Development 15 minutes	$64.00		be submitted by email using the "Contact Us" option on the hospital's web site.
Community/Work Reintegration 15 minutes	$32.00
Evaluation 20 minutes	$96.00
Evaluation 21 - 40 minutes	$106.00
Evaluation 41 - 60 minutes	$117.00
Group Treatment 1	$53.00
Iontophoresis 15 minutes	$59.00
Jobst Pump 1 hour	$52.00
Manual Therapy Techniques	$48.00
Neuromuscular Reeducation, Movement, Balance	$53.00
Occupational Therapy Reevaluation	$75.00
Paraffin Bath	$48.00
Self-care/Home Management Training 15 minutes	$58.00
Sensory Integration Techniques - 15 minutes	$58.00
Splint, Finger Dynamic Application	$186.00
Splint, Finger Static Application	$186.00
Splint, Long Arm Application	$186.00
Splint, Short Arm Dynamic Application	$186.00
Therapeutic Exercise 1 More Area 15 minutes	$53.00
Therapeutic Activities	$43.00
Whirlpool/Fluido Therapy	$48.00
Charge does not include fees for services of physicians.