About Your Bill

St. Margaret's Health is committed to providing quality health care and service to all patients. In order to continue in this mission, it is essential that payment be received for services provided.

 

As a courtesy to our patients and their families, we submit claims to any insurance company according to the guidelines listed in this brochure. To do this efficiently, it is important that insurance information be presented at the time of registration.

 

You, or the responsible party (sometimes called the "guarantor"), will receive statements showing any balance due.

Patient Responsibilities

Prior Authorization

An increasing number of insurance carriers now require authorization prior to your receiving hospital and/or physician services. Most of these plans require either you as policyholder or your physician to initiate the prior authorization procedure.

 

If your insurance has such a requirement, please inform your physician, or contact your insurance carrier. Failure to meet your insurance requirements may result in partial or complete denial of insurance benefits. Our registration staff can assist you in this process.

Patient Responsibility

If insurance payment is not received within 45 days of the Patient Accounts Center submitting a complete claim, payment becomes your responsibility.

Insurance Billing Guidelines

Medicare

St. Margaret's Health is a certified Medicare provider. When supplemental insurance policy information is presented at the time of service, the Patient Accounts Center will submit the claim for deductibles and coinsurance. This supplemental billing can only be completed after Medicare payment has been received and cannot be done unless complete and accurate information is received at the time of service.

While Medicare must be allowed as much time as needed to process a claim, supplemental insurances will have up to 45 days after Medicare pays before the outstanding balance becomes your responsibility.

Medicaid (Public Aid)

Medicaid billings are submitted when complete and accurate information is received at the time of service. You will be notified of any balance due.

Workers Compensation

Charges for services incurred as a result of a work-related injury will be treated as a normal insurance claim. Should the claim be disputed, the outstanding balance will be your responsibility.

Other Insurance

We will bill up to two insurance companies if presented with correct insurance information and assignment of benefits at the time of service. All balances not paid after 45 additional days will become your responsibility.

When The Patient Owes A Balance

We expect you to make a "good faith" effort to pay any balances due St. Margaret's Health. The Patient Accounts Center will work with you to establish a reasonable settlement of all balances that are your
responsibility. An account is considered delinquent when:

  • No payment arrangements have been made within 30 days of final insurance payment (or first billing for self-pay accounts).
  • Terms of established financing arrangements are not met.

If your account is delinquent, you will receive one final notice and a grace period of 10 days to forward any balance due. Disputed balances will be subject to review by the Patient Accounts Center before further collection efforts are pursued. In those cases where the Patient Accounts Center has exhausted all reasonable efforts to collect the balance due, the account will be referred to a licensed collection agency for follow-up and collection.

Financing Options

We have staff available to assist you in establishing financial arrangements to meet your needs. You may contact the Patient Accounts Center for assistance with the following programs:

Credit Cards

We will honor VISA, MasterCard, and Discover cards for the payment of accounts. These payments will be accepted either by phone, in person, or by mail.

Hospital Installment Plan

For accounts with a balance of $250 or more, we will accept payment in the form of twelve equal monthly installments. For accounts under $250, we will accept monthly installments with a $20 per month minimum. Payments are available through direct withdrawal from your checking or savings account (auto withdrawal form). If a payment is missed, the remaining balance must be paid in full within thirty days, or it will be considered delinquent.

Loan Program

We have programs with financial institutions to assist those in need of obtaining financing. We will assist you in securing external financing in those instances where payment arrangements are requested beyond 12 months.

Financial Assistance

Consideration for financial assistance is based on your financial status in comparison with the Federal Poverty Guidelines.

Notice of Availability

St. Margaret's Health is committed to providing care to patients regardless of their ability to pay for part or all of essential medical care.

If you do not have health insurance or are concerned that you may not be able to pay for your care in full, we may be able to help. St. Margaret's Health provides financial assistance to patients based on their income and other resources. In addition, we may be able to work with you to arrange a manageable payment plan.

 

It is important that you let us know if you expect to have difficulty paying your bill. In the absence of a documented financial hardship, federal and state laws require hospitals to seek full payment of what they bill patients. This means that unless we are notified of your financial situation, we may turn unpaid bills over to a collection agency, which could affect your credit status.

 

For more information on financial assistance, please call our Patient Accounts Office at 815-664-1575.

 

We will treat your questions with confidentiality and courtesy.

Financial Assistance /
Uninsured Patient Discount

The philosophy of St. Margaret's Health is that all people have a right to receive needed health care. Our doors are open to persons of every faith and ethnic background regardless of their ability to pay.

 

We provide help to patients in obtaining payment from third parties such as Medicaid and Medicare. If you are eligible for Medicaid, and you are not currently signed up, we can help you apply.

 

We also offer financial assistance for medically necessary healthcare services to persons who meet our financial eligibility terms provided they submit the needed documents. St. Margaret's Financial Assistance/Uninsured Patient Discount can be applied for before services, even with no insurance plan. It can also be applied for when there is a potential balance due on an account after we have received payment from third party payers (like Medicaid, Medicare or an insurance company) and you feel you cannot pay the full balance.

 

The attached form must be completed and signed by you. We use income guidelines established by the U.S. Dept. of Health and Human Services to determine if you are eligible for charity care. Please provide all the information promptly so we may try to help you as quickly as possible.

 

If you have any questions about St. Margaret's Financial Assistance or any other offers of assistance, please call our Patient Accounts Center at 815.664.1575 between 8 a.m. and 5 p.m. Monday through Friday.

 

St. Margaret's Health offers high quality healthcare and we are pleased to care for you and your family. We look forward to working with you further to make sure the financial aspects of your care are handled in the same high quality way.

 

Download Financial Assistance Form

Financial Assistance Policy & Plain Language Summary

It is the policy of St. Margaret's Health, a nonprofit organization, to offer full or partial Financial Assistance to any qualified patient, with or without insurance, who seeks help in paying for eligible healthcare services received.

 

Eligible services for assistance:

Emergent or Medically Necessary services received from St. Margaret's Hospital, Durable Medical Equipment, hospital owned Clinics, and employed physicians. Physicians who are not employed by St. Margaret's, such as Radiologists, Anesthesiologists, Pulmonologists, and Pathologists are examples of services not eligible under this program.

 

How to apply for assistance: 

Download an application for assistance. To request an application be mailed or to pickup in person, please contact St. Margaret's Patient Accounts Center located at 221 W. St. Paul Street, Spring Valley, IL  61362,  or phone (815) 664-1575.

 

Completed and signed applications are to be returned to Patient Accounts Center with required documentation.

 

Eligibility requirements and assistance offered:

Eligibility for Financial Assistance, means patients may have their care partially or fully covered, and they will not be billed more than amounts generally billed to insured persons. To determine amounts generally billed we use a look-back method. Qualified patients may be granted financial assistance ranging from 10% to 100% based on Income Level compared to the National Poverty Guidelines or based on the Illinois Hospital Uninsured Patient Discount Act, SB2380, effective April 1, 2009.

 

If applicant or household income is less than 150% of poverty guidelines, financial assistance may be granted at 100%.

 

If applicant or household income is over 150% of Guidelines, but not more than 250% of Guidelines, financial assistance may be granted using a sliding scale, 10%- 90%.

 

Presumptive eligibility may also be granted based on Title 77: Public Health Chapter XVIII: Office of the Inspector General Part 4500 Hospital Financial Assistance under the Fair Patient Billing Act, Section 4500.40 Presumptive Eligibility Criteria effective October 10, 2014. For the purpose of this policy, household income is defined, in most cases, as people living together acting as a family unit, or being claimed as dependants on the Federal Income Tax Return. Exceptions for qualification may be made in certain situations.
Patient portions are to be paid according to hospital policy for self pay accounts, based on the date of notification.

 

Applications not completed, or missing documentation may be denied. Submitted applications are reviewed and applicants will be notified of decision.

 

Contact for Questions regarding assistance:

Staff is available to help with any questions you have regarding Financial Assistance, and can be reached at St. Margaret's Patient Accounts Center, 221 W. St. Paul, Street, Spring Valley, IL  61362, Phone (815) 664-1575, Fax (815) 664-1188.

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