{"id":1019,"date":"2017-06-13T14:30:24","date_gmt":"2017-06-13T19:30:24","guid":{"rendered":"https:\/\/aboutsmh.org\/\/?page_id=1019"},"modified":"2021-12-21T11:56:40","modified_gmt":"2021-12-21T17:56:40","slug":"billing-insurance","status":"publish","type":"page","link":"https:\/\/aboutsmh.org\/billing-insurance\/","title":{"rendered":"Billing & Insurance"},"content":{"rendered":"\t\t
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Have a question about billing or how insurance is handled? Below, you will find information on our billing and insurance handling, included an FAQ section.<\/p>

We will bill your insurance company as a courtesy to you and will do everything possible to expedite your claim, but you please remember your insurance policy is a contract between you and your insurance company. Therefore, you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill.<\/span><\/p>

Your hospital bill reflects all of the services you receive during your stay. Charges fall into two categories:<\/p>

  1. A basic daily rate which includes your room, meals, nursing care, housekeeping, telephone and television;<\/li>
  2. Charges for special services, which includes items your physician orders for you such as x-rays, laboratory tests, supplies, or equipment.<\/li><\/ol>

    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.<\/p>

    Click here for a listing of insurance networks in which St. Margaret’s Health – Spring Valley participates.<\/a><\/p>

    Click here for a listing of insurance networks in which St. Margaret’s Health – Peru participates.<\/a><\/p>

    Financial Arrangements<\/h3>

    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.<\/p>

    Charges & Price Transparency<\/h3>

    To see our standard charges for services at both St. Margaret’s Health – Spring Valley and St. Margaret’s Health – Peru, or for \u00a0healthcare price transparency with contracted insurance companies, as required by CMS, click the button below to visit our charges and price transparency page.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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    Billing & Insurance FAQs<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    \n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tPhysician Services<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

    We will bill for physicians and other healthcare providers who are part of St. Margaret’s Health. We also bill for St. Margaret’s Emergency Room physicians and for some physician-provided cardiology services. All other physician are independent practitioners and will bill you or your insurance carrier directly.\u00a0<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    It is important for you to know if your insurance company or HMO\/PPO require recertification for any care provided at a hospital. If recertification is required and you or your physician do not take steps to ensure this authorization is obtained, you may be responsible for reduced benefits due to penalty costs or possible denial of the entire claim.\u00a0<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    Within 45 days after billing, you will be billed for any balance due.\u00a0We will need a copy of your insurance identification card. Benefits are assigned from the insurance company directly to the hospital.\u00a0If you have not provided us with adequate information to bill your insurance company, we will bill you.\u00a0<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    Click here<\/a> for a listing of insurance networks in which St. Margaret’s Health – Spring Valley participates.<\/p>

    Click here<\/a>\u00a0for a listing of insurance networks in which St. Margaret’s Health – Peru participates.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    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.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    A representative from the St. Margaret’s Patient Accounts Center will discuss financial options and arrangements with you.\u00a0<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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    We will bill Medicare for all covered charges and also bill one supplemental insurance plan for you for the balance if you have provided us with that information. If payment is not received within 30 days from your secondary insurance, we will ask you to contact your insurance carrier to speed up the payment. If you do not have a secondary insurance, we will bill you directly for the remaining balance.<\/p>

    We need a copy of your Medicare card to verify eligibility and to process your Medicare claim.<\/p>

    Medicare does not cover all services provided in the hospital setting. Here are some examples of uncovered Medicare Services:<\/p>