MIAMI VALLEY HOSPITAL
DAYTON, OH · version 1 · published · JSON
eligibility.free_care_max_fpl200% of the federal poverty level"0% - 100% 100% 100% 100% - 200% 100% 100%"
documented · checked 2026-10-14 · Financial Assistance Policy
eligibility.discount_tiersAbove 200% up to 300% of FPL: 80% discount"% of Poverty Level Uninsured *Insured 0% - 100% 100% 100% 100% - 200% 100% 100% 200% - 300% 80%/AGB 80%/AGB"
documented · checked 2026-10-14 · Financial Assistance Policy
eligibility.insured_patients_coveredYes"*Insured percentages apply to non-covered charges determined by insurance as patient responsibility. Examples include cost sharing insurance determined copays, deductibles, and co-insurance percentages."
documented · checked 2026-10-14 · Financial Assistance Policy
apply.documents_requiredProof of incomeSocial Security letter
Tax return
Pay stubs
"Proof of Income and Assets, if applicable, must be provided to complete processing of this application. Please check type of income & asset verification attached: [ ] Copies of Pay Stubs for 3 and/or 12 months prior to date of service [ ] Letter from Employer(s) stating gross income for 3 and/or 12 months prior to date of service [ ] Income Tax Return(s) [ ] Social Security Letter(s) [ ] All W-2's for the household [ ] Other (Deed. Car Registration)"
documented · checked 2026-10-14 · [PDF] Financial Assistance English - Premier Health
apply.submit_methodsIn person: Applications are also available on the reverse side of the patient’s billing statement.Portal: To apply for financial assistance, patients must submit a complete application including supporting documents upon request, in person, by mail, via email, or through MyChart.
"Financial Assistance Program applications, which are used for both HCAP and Premier Health Hospitals’ Financial Assistance Program, are available in the registration and financial counseling areas of the hospitals, and on the Premier Health Hospitals’ web sites."
documented · checked 2026-10-14 · Financial Assistance Policy
apply.window_days_from_first_bill240 days"Patients can apply for financial assistance through the Financial Assistance Program before, during or after receiving Emergency or Medically Necessary care, up to 240 days after the first post discharge statement."
documented · checked 2026-10-14 · Financial Assistance Policy
apply.decision_days30 days"Notify the patient in writing regarding the decision within 30 days from the date of the decision."
documented · checked 2026-10-14 · Financial Assistance Policy
collections.eca_wait_days120 days"Premier Health Hospitals will not initiate any ECAs for at least one hundred and twenty (120) days from the date the hospital facility provides the first post-discharge billing statement for the care."
documented · checked 2026-10-14 · Financial Assistance Policy
contacts.phone(937) 499-7364"For any questions on how to complete this form, call Customer Service at (937) 499-7364."
documented · checked 2026-10-14 · [PDF] Financial Assistance English - Premier Health
contacts.hours8 am to 7 pm weekdays"Financial counseling office hours are generally 8 am to 7 pm weekdays and can be reached by calling 937-499-7364."
documented · checked 2026-10-14 · Financial Assistance Policy
contacts.languagesEnglishSpanish
"Applications are available in English and in Spanish."
documented · checked 2026-10-14 · Financial Assistance Policy
coverage.facilitiesAtrium Medical CenterMiami Valley Hospital
Upper Valley Medical Center
"Premier Health Hospitals Care Assurance / Financial Assistance Program Atrium Medical Center Miami Valley Hospital Upper Valley Medical Center"
documented · checked 2026-10-14 · [PDF] Financial Assistance English - Premier Health
Sources
[PDF] Financial Assistance English - Premier Health — fetched 2026-10-14
Financial Assistance| Billing | Premier Health — fetched 2026-10-14
Financial Assistance Policy — fetched 2026-10-14
Financial Assistance| Billing | Premier Health — fetched 2026-10-14
Financial Assistance – English version — fetched 2026-10-14
Financial Assistance – Spanish version — fetched 2026-10-14
Financial Policy – Spanish version — fetched 2026-10-14