Patient Notices

View and/or download a copy of the Notice of Privacy Policy HERE.

View and/or download a copy of the No Surprises Act HERE.

Additional Patient FAQ

Yes we do.
What insurances do we accept? Davis County Hospital and Davis County Medical Associates accepts multiple insurance payments. To insure that they will cover services at our facility we would recommend that you contact your insurance company to make sure that our facility and physicians are on your insurance preferred provider list. This would eliminate any confusion and insure that they will pay the maximum amount according to your policy.

The information contained in this file is being provided in compliance with the Centers for Medicare and Medicaid Services (CMS) requirement [FY 2019 IPPS/LTCH PPS Final Rule; CMS-1694-F] for hospitals to post a list of their standard charges online in a machine-readable format.

By clicking to download this information you agree you have read and understand the following:

i. The information contained in the file is current as of the last upload. Charge information is subject to periodic changes and the file will be updated as soon as practically possible to reflect such changes
ii. The file contains both the charge amount and the charge description of the item or service as reflected in the hospital's charge master (CDM)
iii. A charge represents the dollar amount assigned to specific medical services before application of any negotiated discounts to third-party payers. The actual hospital charges will vary based on the type of care provided, treatments, individual health conditions and other factors. If you need an exact estimate of your out-of-pocket cost, please call or submit a request online as described elsewhere on this website. PLEASE NOTE THESE CHARGES MAY NOT INCLUDE FEES FROM YOUR SURGEON OR OTHER PROFESSIONAL SERVICES BILLED BY THE PHYSICIAN AND OTHER PROFESSIONAL PROVIDERS. Typically, you will be billed separately for these professional services
iv. Following the CMS guidelines, the information in this file represents the hospitals current standard charges as reflected in the CDM. However, it is important to understand that the information represented in the CDM is the starting point in many cases and can undergo additional adjustments through the billing process, therefore, please be aware:

  1. The charge shown is the original charge for the item or service prior to any adjustments that result from applying modifiers in certain situations
  2. The CDM is used in multiple hospital departments and may have different charges for the same item or service and such instances will repeat in the file. For a single charge master item, the charge is consistent; however, there may be slight variation in charges for services with similar descriptions for various reasons
  3. Charges for certain items or services are based on per unit, such as – including but not limited to – surgeries, anesthesia, and recovery which can be based on the unit of time and complexity; medications, drugs which can be based on weight-based dosage, age or packaging; etc.
  4. Certain items and or services have a zero dollar price in the CDM for a variety of reasons – contracted billing services that drop charges externally, no cost supplies, Investigation device or medication exemption items in clinical trials and studies, replacement for a recalled or defective device, explode codes and other system limitations. Such items and services will appear with zero dollar and is not reflective of the actual charge. In addition, items and or services are sometimes assigned a one penny price to reflect, for example, a state provided medication or drug, contrast items, therapy status codes used for CMS reporting, etc. and Is not reflective of the actual charge contained outside of the charge master,

v. The file may also contain CDM items for non-charges (such as payments, allowances, transactions, etc.)

The file is voluminous and download may take excessive time depending on your internet speed.

By clicking to download this information you agree you have read and understand the above.

Click here to download the hospital's current standard charges

Testing for Coronavirus (COVID-19) is $135.00; patient responsibility is $0.

You will not need to bring anything specific with you the day of your mammogram exam. We will ask you a few questions to update our records recording your medical history. Questions you will be asked will be centered on your health history and will include: How old you were when you had your first menstrual cycle. How old you were with your first pregnancy. Do you have a family history of breast cancer? What was the date and year of your hysterectomy? Do you have a history of breast surgery? The answers to these questions will aide in performing your mammogram and help us know your risk factors.

Davis County Hospital’s billing department is set up to send one bill for professional fees and a separate for facility fees. If you have any questions regarding your bill please contact the hospital by calling 641-664-2145.

The Davis County Hospital financial department is set up to process bills on a per visit basis. Each time you come to our facility we process your visit, if you are at our facility two times in one week you will receive a bill for each visit made during the week.

Davis County Hospital contracts with a physicians group that reads and interprets the radiology procedures. They take care of billing their services separate from Davis County Hospital.

It is best to come to your appointment 15 minutes early. This will allow plenty of time to for you to register prior to your appointment time.

It is best if you can bring all of your medications any time you visit the facility. This will insure that our records are update and don’t require you to have to remember the correct spelling, dose or instructions.

Davis County Hospital has a trained financial counselor available to discuss your individual needs.

If you do not have insurance or will have difficulty in paying your portion of the bill, our counselor can assist you with your needs in making payment arrangements, reviewing for Davis County Hospital Financial Assistance Program or in case of hospital admission a referral for public assistance.

Regardless, patients will receive necessary medical care and the care will never be based on the patient’s ability to pay.

You can review the Plain Language Summary of Davis County Hospital Financial Assistance Policy here: Plain Language Summary of DCH Financial Assistance Policy

You can review the Financial Assistance Program Policy for Davis County Hospital here: Policy - Financial Assistance Program

Financial Assistance is a program available at the Davis County Hospital that assist people who cannot afford medical care – this includes the uninsured and even the underinsured. Our financial counselor or registration staff would be happy to help determine if you qualify and completing the require paperwork.

If you do qualify your financial assistance will cover all or part of the cost associated with medically necessary services provided at Davis County Hospital. This could include Emergency Room visits, laboratory tests, surgery, in or outpatient services and any medication you received while a patient in our facility.

For more information regarding our Financial Assistance Program please contact Angela Jones at extension 2420.

Financial Assistance Application

Prompt Pay Discount Davis County Hospital offers a prompt pay discount for all their patient’s.

Accounts that are paid in full within 30 days from the date of the patient’s first statement, excluding all pre-set co-pays (physician office and ER), are eligible for a 10% discount.

If you have any questions regarding our discount policy please contact Angela Jones, at ext. 2420.

The Davis County Hospital will not become involved in disputes arising from personal injury claims such as automobile accidents, falls or other liability situations. We will be to provide the necessary billing information and copies of your Medical Records, with proper consent from you. However, the financial responsibility for our services always rests with you.

Davis County Hospital will not become involved in family disputes arising from situations of divorce, custody or other matters. The hospital will not be a party to any divorce decree or separation papers you may have and is not bound by the terms of the document. We will hold the parent who brought the child to the hospital for service responsible for payment of the account.

If you have been injured in some manner, such as a vehicle accident, fall or etc., Davis County Hospital will bill your insurance company first, then the liability carrier you specify for any deductible or co-payments your health insurance does not pay.

Although another party may have some legal responsibility for your injuries, this matter is between you, your attorney and the party responsible for the injury.

If you are a Medicare or Medicaid recipient, health care law requires that we bill the liability carrier first then Medicare or Medicaid.

When you are registered as a patient at the Davis County Hospital you will be asked questions regarding:

  • During the patient registration process you will be asked to present an update insurance card or information regarding your insurance carrier. Additional information that you may be asked for includes specific forms or original documentation needed by your insurance carrier. This information may include claim forms, authorizations, referrals, etc.
  • As a service to our patients, Davis County Hospital will file your insurance claim with your carrier, but you are ultimately responsible for paying for the services you receive.
  • At the time of registration you will be asked to pay any deductibles and co-pays your insurance may have in place. The facility provides several options for you to make those payments including cash, checks, Master Card, Visa and Discover.
  • Davis County Hospital understands that there may be times when you faced with an illness and are underinsured or uninsured. Staff will be happy to visit with you regarding financial assistance, and your individual needs.
  • Patients at Davis County Hospital will always receive care that is medical necessary regardless of their ability to pay.

Fee Reductions:

Our fees are accepted by most insurance plans as “usual, customary and reasonable.” We do not make UCR reduction unless we have a contractual arrangement with your insurance company.

Non Covered Services

Insurance companies do not pay for all medical services, even those that might be helpful to a patient. When a service is not covered by your insurance policy, you are responsible for paying the bill. Services that may be included are:

  • Procedures, visits, tests, etc.
  • Medications
  • Supplies

Physicians dictate your diagnosis for each visit or procedure. We are unable to change this information just so the claim will be paid.

Pre-Certification

Many insurance plans have pre-certification requirements. Generally, you or your physician is responsible for obtaining pre-certification.

Most insurance companies will not accept pre-certification from the hospital.

To avoid penalties or reduction of payments, for which you will be responsible, call your insurance carrier for specific information.

TO REPORT A HIPAA or COMPLIANCE VIOLATION

Report it on the HOTLINE (866-477-4661)

Davis County Hospital would like to thank you for having the confidence in us to allow us to serve your healthcare needs. To make your visit to our facility less stressful, we would like to provide you with information that you will need to know concerning your visit, documentation you will need for your visit and additional information that will make the registration and payment process easier.

Registration

The Registration Department is usually a patient’s first stop on the way to a scheduled inpatient test, procedure or surgery. Although your physician has already scheduled the procedure for you or you have made an appointment to see one of our physicians.

To help provide a smooth registration process we ask that you bring the following information with you to your physician appointment, ER Visit or scheduled procedure:

Patient Social Security Number
Current insurance card or information regarding your current insurance
Valid photo I.D.
Employment Information
Name of primary care provider
List of medications, including dosage or the medication itself
Past health history
Bring a copy of patient’s advance directive (if available) for patient record filing purposes.
For appointments involving procedures, be sure to contact your insurance company before your visit to meet any pre-authorization requirements. If requirements are not met, the patient’s benefits may be reduced leaving the patient responsible for most or the entire hospital bill.

Medicare Patients:

At the time of registration Medicare patients will be asked a series of questions which are required by Medicare at the time of registration.

They will include:

Are your eligible for Age Disability Federal Coverage?
Is Medicare primary or secondary payer for your visit?

Financial Assistance

Financial Assistance is a program available at the Davis County Hospital that assist people who cannot afford medical care – this includes the uninsured and even the underinsured. Our financial counselor or registration staff would be happy to help determine if you qualify and completing the require paperwork.

If you do qualify your financial assistance will cover all or part of the cost associated with medically necessary services provided at Davis County Hospital. This could include Emergency Room visits, laboratory tests, surgery, in or outpatient services and any medication you received while a patient in our facility.

For more information regarding our Financial Assistance Program please contact Angela Jones at extension 2420.

Financial Assistance Application

Understanding Your Bill

Davis County Hospital is committed to helping you understand your hospital bill.

Davis County Hospital works with a company called First Party for patient billing and collection services. Your bill will be sent directly to you from First Party’s offices located in Colorado Springs, CO. The business envelope containing your bill will list “Davis County Hospital” on the return address, but will list a Colorado Springs address.

Although the bill is generated in Colorado Springs, CO, our local business office has the original record and is available to answer any questions you have about your payment.

You can contact the Davis County Hospital business office at (641) 664-2145.

Patient Financial Services Contacts

If you have any questions or concerns regarding your bill for services provided at Davis County Hospital or Davis County Hospital Medical Associates please feel free to contact us.

Patient Accounts

Jackie Burdett
641-664-2145, ext. 2212

Financial Counselor

Angela Jones
641-664-2145, ext. 2420

Insurance Department

Please call 641-664-2145 and ask for the Insurance Department.

Financial Services or Self Pay

641-664-7144