{"hospital":{"ccn":"360076","name":"ATRIUM MEDICAL CENTER","city":"FRANKLIN","state":"OH","zip":"45005","phone":"513-420-5102","ownership":"Voluntary non-profit - Private","website_domain":"premierhealth.com","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"100% – 200%  100%  100%","source_id":"fap-b84d42b3390521f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"discount_tiers":{"value":[{"min_fpl_exclusive":"200","max_fpl_inclusive":"300","discount_percent":80}],"layer":"documented","quote":"Income (of FPG) % of Poverty Level\n\nUninsured Charity Discount\n\nInsured Charity Discount\n\n0 – 100%  100%  100%\n\n100% – 200%  100%  100%\n\n200% - 300%  80%/AGB  80%/AGB","source_id":"fap-b84d42b3390521f4","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"asset_test":null,"residency":null,"insured_patients_covered":null,"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","pay_stubs","bank_statements"],"layer":"documented","quote":"Proof of income for applicant (and spouse if applicable) such as a pay stub, unemployment insurance payment stubs, or sufficient information on how patients are currently financially supporting themselves.\nb. Bank Statement\nc. Social Security Statement\nd. Tax Return – Schedule C for self-employment income\ne. Documentation of the family’s assets.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"PO Box 932715, Cleveland, OH 44193"},{"kind":"email","detail":"via email"},{"kind":"portal","detail":"through MyChart"},{"kind":"in_person","detail":"in person"}],"layer":"documented","quote":"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.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"up to 240 days after the first post discharge statement.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days":{"value":30,"layer":"documented","quote":"Notify the patient in writing regarding the decision within 30 days from the date of the decision.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"decision_days_reported":null},"collections":{"eca_wait_days":{"value":120,"layer":"documented","quote":"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.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"collection_agencies":null},"contacts":{"phone":{"value":"937-499-7364","layer":"documented","quote":"Financial counseling office hours are generally 8 am to 7 pm weekdays and can be reached by calling 937-499-7364.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"hours":{"value":"8 am to 7 pm weekdays","layer":"documented","quote":"Financial counseling office hours are generally 8 am to 7 pm weekdays and can be reached by calling 937-499-7364.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"languages":{"value":["English","Spanish"],"layer":"documented","quote":"Applications are available in English and in Spanish.","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Atrium Medical Center"],"layer":"documented","quote":"All hospitals are referred to collectively in this policy as “Premier Health Hospitals.” All Premier Physician Network providers are referred to collectively in this policy as “PPN.”","source_id":"fap-27791e6a031acdbf","checked_on":"2026-10-11","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-27791e6a031acdbf","kind":"hospital_web","url":"https://www.premierhealth.com/docs/default-source/default-document-library/financial-assistance-policy.pdf?sfvrsn=8b77b8df_14","title":"Tier 2 Financial Assistance Policy Template","fetched_on":"2026-10-11","sha256":"27791e6a031acdbf6d68c8ee445f3ef425f84da274f8fe141ac3ff585fe3ddb4","effective_date":null},{"id":"billing-76eedf79a424e1ed","kind":"hospital_web","url":"https://www.premierhealth.com/patient-and-visitor-guide/patient-guide/costs-and-insurance/billing/financial-assistance","title":"Financial Assistance| Billing | Premier Health","fetched_on":"2026-10-11","sha256":"76eedf79a424e1ed2c922d07624c310902c8a4649d54926f914f2e92a1095844","effective_date":null},{"id":"fap-b84d42b3390521f4","kind":"hospital_web","url":"https://www.premierhealth.com/docs/default-source/default-document-library/fap-handout-(2).pdf?sfvrsn=a68b8c22_0","title":"Ohio Hospital Care Assurance Program (HCAP)","fetched_on":"2026-10-11","sha256":"b84d42b3390521f43f71dfe346a418c28613b7e3c186e9bb08274aab75ddfd2f","effective_date":null},{"id":"fap-ed64527eecfc5fc7","kind":"hospital_web","url":"https://www.premierhealth.com/docs/default-source/default-document-library/financial-assistance-english-version.pdf?sfvrsn=6a042e28_7","title":"financial-assistance-english-version.pdf","fetched_on":"2026-10-11","sha256":"ed64527eecfc5fc752cac73d5c20ea9f3893519cab66ae08e0b97a412b9dc1cb","effective_date":null}],"accuracy":null}