Have a question about billing or how insurance is handled? Here is a list of some common billing, insurance, medicare and medicaid questions.
We will bill your insurance company as a courtesy to you and will do everything possible to expedite your claim.
But you should remember that your insurance policy is a contract between you and your insurance company 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 hospital 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, telephone and television;
- Charges for special services which includes items your physician orders for you such as x-rays, laboratory tests, supplies, or equipment.
If you have certain tests or treatments in the hospital, you may receive bills from a physician whom you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting tests results while you were a patient. Pathologists, radiologists, and other specialists perform these services and are required to submit separate bills. Your physician and any consulting physicians will also submit a separate bill. If you have any questions about these bills, please call the number or write to the address printed on the statement you receive.
If You Have Health Insurance
We will need a copy of your insurance identification card. Benefits are assigned from the insurance company directly to the hospital.
If You Have No Insurance
A representative from the Patient Accounts Department will discuss financial options and arrangements with you.
You should familiarize yourself with the terms of your insurance coverage. This will help you understand our hospital’s billing procedures and charges. If there is a question about your insurance coverage, a member of the Patient Accounts Department will contact you or a member of your family. There is information we will need to process your claim.
If You Are a Member of a HMO or PPO
Your plan may have special requirements such as second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered. If St. Margaret’s is not part of your HMO or PPO, please dial extension 1619 to discuss your options with our Managed Care Coordinator.
If You Are Covered by Medicare
We need a copy of your Medicare card to verify eligibility and to process your Medicare claim. You should be aware that the Medicare program does not cover payment for certain items and services, including, but not limited to, cosmetic surgery, some oral surgery procedures, self-administered drugs, personal comfort items, and hearing evaluations. Deductibles and co-payments also are the responsibility of the patient.
If You Are Covered by Medicaid
We need a copy of your Medicaid card. Medicaid also has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary and documented by your physician’s written order.