{"hospital":{"ccn":"360056","name":"MERCY HEALTH - FAIRFIELD HOSPITAL","city":"FAIRFIELD","state":"OH","zip":"45014","phone":"513-870-7000","ownership":"Voluntary non-profit - Private","website_domain":"mercy.com","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Individuals with an income level at 200% FPG or below receive free care.","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"assistance_ceiling_fpl":null,"asset_test":{"value":true,"layer":"documented","quote":"There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BSMH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient’s essential daily living expenses.","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"It covers patients without health insurance and those with only partial insurance coverage (i.e. the uninsured and underinsured) who meet the income and other eligibility criteria described herein.","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":null,"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"mailing a request to Bon Secours Mercy Health, 11511 Reed Hartmann Highway, Blue Ash, OH 45241, Attn: Financial Counseling"},{"kind":"portal","detail":"by visiting our website at www.bsmhealth.org/financial-assistance, www.mercy.com/financial-assistance, and www.fa.bonsecours.com"},{"kind":"phone","detail":"by contacting Bon Secours Mercy Health Patient Financial Services by telephone at 1-877-918-5400"},{"kind":"in_person","detail":"by contacting our financial counselors in person at any of our hospital locations"}],"layer":"documented","quote":"You may obtain a copy of our HFA Policy and the HFA Application Form, as well as information about the financial assistance application process: (i) by visiting our website at www.bsmhealth.org/financial-assistance, www.mercy.com/financial-assistance, and www.fa.bonsecours.com, (ii) by contacting Bon Secours Mercy Health Patient Financial Services by telephone at 1-877-918-5400, (iii) by mailing a request to Bon Secours Mercy Health, 11511 Reed Hartmann Highway, Blue Ash, OH 45241, Attn: Financial Counseling, or (iv) by contacting our financial counselors in person at any of our hospital locations (see the full HFA Policy for a complete listing of facilities and addresses).","source_id":"summary-ff4bd0a9e1038426","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":null,"hours":null,"languages":{"value":["English","Arabic","Cambodian","Cantonese","Dari","French","Gujarati","Haitian Creole","Hindi","Korean","Mandarin","Nepali","Pashto","Portuguese","Punjabi","Russian","Spanish","Swahili","Uzbek","Vietnamese"],"layer":"documented","quote":"Printable Financial Assistance Application (Select Language)\n* [English](/-/media/mercy/patient-resources/financial-assistance/2024/english/mercy-health-2024-application_final_clean.pdf)\n* [Arabic](/-/media/mercy/patient-resources/financial-assistance/2024/arabic/mercy-health-application-arabic.pdf)","source_id":"fap-9fa0eaccee4d2151","checked_on":"2026-10-14","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Mercy Health - Fairfield Hospital"],"layer":"documented","quote":"Mercy Health – Fairfield Hospital 3000 Mack Road Fairfield, Ohio 45014 Dept: Financial Counseling","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-df3f019cf294baf8","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/hfa-policy-502/english.ashx","title":"[PDF] Healthcare Financial Assistance (HFA) Policy Number - Mercy Health","fetched_on":"2026-10-14","sha256":"df3f019cf294baf8f40a41fdea8b1a03bf995af4669bf1eaf3fc7f9671e793b3","effective_date":null},{"id":"summary-ff4bd0a9e1038426","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/assistance-summary/financial-assistance-summary-english.ashx?la=en","title":"Microsoft Word - Plain Language Summary_Mercy Health.docx","fetched_on":"2026-10-14","sha256":"ff4bd0a9e103842607c1827aecef1156f6f2db2d44fedfc0f63f42abc4919a3b","effective_date":null},{"id":"billing-f04a957b290c2a47","kind":"hospital_web","url":"https://www.mercy.com/pay-a-bill/faq","title":"Billing and Payment FAQs | Mercy Health","fetched_on":"2026-10-14","sha256":"f04a957b290c2a472b4fa0615e7d4a56fc0edc134040b4517888a44ee19fdce2","effective_date":null},{"id":"fap-9fa0eaccee4d2151","kind":"hospital_web","url":"https://www.mercy.com/patient-resources/financial-assistance","title":"Financial Assistance Policy | Patient Resources | Mercy Health","fetched_on":"2026-10-14","sha256":"9fa0eaccee4d2151836c04c91009f8eda2582ddee899a500bd8a636755f07f92","effective_date":null},{"id":"fap-a34845e04234d0e5","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/2024-bsmh-agb-statement_final.pdf","title":"English","fetched_on":"2026-10-14","sha256":"a34845e04234d0e5dcd129b0f9088712c69484985e98827713108bd39c09e0ad","effective_date":null},{"id":"fap-b1615f0e35d6db58","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/agb/arabic.pdf","title":"Arabic","fetched_on":"2026-10-14","sha256":"b1615f0e35d6db5803fdba5403de58b14d9d0d169eb926b1073b9fa8a243ece3","effective_date":null},{"id":"fap-8ddb22ab9d72ab2f","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/agb/cambodian.pdf","title":"Cambodian","fetched_on":"2026-10-14","sha256":"8ddb22ab9d72ab2f4b836c5cdca10fd4a2eaa1718dce9711f3d44f0817926b2e","effective_date":null},{"id":"fap-a37957c5641b5b6c","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/agb/cantonese.pdf","title":"Cantonese","fetched_on":"2026-10-14","sha256":"a37957c5641b5b6cb37fa3504687c524c0eece56219462149ee2778f81565a3b","effective_date":null}],"accuracy":null}