{"hospital":{"ccn":"360066","name":"MERCY HEALTH ST RITAS MEDICAL CENTER","city":"LIMA","state":"OH","zip":"45801","phone":"419-227-3361","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,"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":{"value":["proof_of_income","social_security_letter","tax_return","bank_statements"],"layer":"documented","quote":"# FOR INCOME ASSETS LISTED ABOVE YOU MUST PROVIDE THE FOLLOWING FOR EACH MEMBER OF THE HOUSEHOLD:\n\n(please check items received)\n\n☐ EMPLOYMENT = 3 OR 12 MONTH INCOME ☐ SELF EMPLOYMENT = COMPLETE TAX FORMS INCLUDING SCHEDULE C\n\n☐ UNEMPLOYMENT = BENEFIT LETTER ☐ CHILD SUPPORT = COURT ORDERED DOCUMENT\n\n☐ SOCIAL SECURITY = BENEFIT LETTER ☐ OTHER= PROOF OF ANY OTHER INCOME SUCH AS DIVIDENDS, INTEREST, RENTAL INCOME\n\n☐ PENSION OR DISABILITY= BENEFIT LETTER ☐ CHECKING / SAVINGS = CURRENT 30 DAY STATEMENT FOR EACH ACCOUNT","source_id":"application-078bcf158f8c97b0","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Approved applications will be honored for a period of 240 days from the initial date of service and are not applied retrospectively to prior dates of service in which the application period has expired.","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":{"value":120,"layer":"documented","quote":"BSMH will notify individuals about the HFA Policy as described herein before initiating any ECAs to obtain payment for the care and refrain from initiating such ECAs for at least 120 days from the first post-discharge billing statement for the care.","source_id":"billing-3dc43427751ac1ef","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"1-855-732-0138","layer":"documented","quote":"Telephone 1-855-732-0138","source_id":"fap-df3f019cf294baf8","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"hours":null,"languages":null},"coverage":{"facilities":{"value":["Mercy Health - St. Rita’s Medical Center"],"layer":"documented","quote":"Mercy Health - St. Rita’s Medical Center 730 W. Market St. Lima, OH 45801 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":"application-078bcf158f8c97b0","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/mercy-health-financial-assistance-application-english.ashx","title":"BSMHMG_Mercy Health 2024 Application_Final_Clean","fetched_on":"2026-10-14","sha256":"078bcf158f8c97b0699ef09d42b0191af0ee88845549b3ad62400eb07d56031b","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-3dc43427751ac1ef","kind":"hospital_web","url":"https://www.mercy.com/-/media/mercy/patient-resources/financial-assistance/billing-collections-policy-503/english.ashx","title":"English.pdf","fetched_on":"2026-10-14","sha256":"3dc43427751ac1efcc12821f81e180dc4d5cef5f99fa0a584a90415027b3069f","effective_date":null}],"accuracy":null}