To help you understand the hospital’s billing procedures and charges, you should become familiar with the terms of your health plan coverage. If additional information regarding your health plan is needed, a member of the business office staff will contact you or a member of your family while you are here.
If You Have Health Insurance
We may need a copy of your insurance card and any insurance forms which are required by your employer or the insurance company. You will be asked to assign benefits from the insurance company directly to the hospital.
If You Are a Member of an HMO or PPO
Our facility strives to contract with most managed care health plans, however, this is not always the case. Your health plan will provide you a listing of approved network facility and physician providers. If you elect to receive services by a facility or physician not listed within your health plan network, you may be financially responsible for an additional portion or all of the services rendered. Your health plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure these requirements have been fulfilled. If your health plan requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital.
If You Are Covered by Medicare
Medicare has payment limitations on a number of services and items, which will be the responsibility of the patient. These may include the cost difference between a semi-private and private room, cosmetic surgery, most dental procedures, deductibles, coinsurance and others as identified within your Medicare Handbook. To qualify for Medicare payment, all covered services received must fall within Medicare’s criteria to establish the medical necessity of the services. If this criteria is not fulfilled, you will be notified prior to the services being rendered.
If You Are Covered by Medicaid
Medicaid has payment limitations on a number of services and items which will be the responsibility of the patient. These may include the cost difference between a semi-private and private room, dental procedures, spenddown deductibles, etc.
If You Have No Insurance
A representative from the Department of Human Services (DHS) is also available to assist you in applying for Medicaid or other government assistance programs. If you do not qualify for any medical assistance programs, a representative from the Financial Counseling Office will discuss alternative financial arrangements with you.
Your Hospital Bill
The hospital is responsible for submitting claims to your third party health plan payer and will do everything possible to expedite submission and payment of your claim. However, please be aware that your policy is a contract between you and your health plan, and you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill. Your bill reflects all of the services you receive during your stay. Charges fall into two categories: a basic daily rate, which includes your room, meals, nursing care, housekeeping and telephone; and charges for special services which include items your physician orders for you, such as x-rays, laboratory tests, surgical services, etc. If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these physicians for diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists and other specialists perform these services, and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.