Frequently Asked Questions
Q: When will I receive a statement?
A. Bills for services rendered are sent after insurance has processed.
Q. Can you mail me a copy of my itemized bill?
Q. What is my current account balance?
Q. Can I have two separate accounts on payment plans?
A. Yes, many accounts can be combined into a single payment plan. However, future visits will not be automatically combined with an established plan. There can be times that we set you up on separate payment plans, due to the date the original plan was established.
Q. Why do I get a separate bill for hospital services?
A. To send a claim to the insurance company, the hospital is required to file a separate claim for each inpatient or outpatient visit. In general, outpatient visits on the same day are combined to a single claim. This can only be done if the same physician ordered the services. If your physician’s office is a hospital department the billing of the professional services may be on the same account .
Q. Who can I contact with questions about my statement?
A. Customer Service representatives are available to help you via email and over the phone with any questions or concerns you may have about your bill. See Contact us
Q. Can I view my payment history online?
Q. Will the hospital bill my insurance company for me?
A. Yes. The primary, and if applicable secondary, insurance coverage you present at the time of registration will be billed.
Q: Will the hospital file my worker’s compensation claims for me?
A. Yes. The hospital will bill worker's compensation insurance and make all appropriate first report of injury information available to the liability carrier and third party administrators.
Q. It has been several weeks since my hospital visit, why haven't I received a bill?
A. We will always bill the medical insurance on file first. Once the insurance pays its portion, any remaining amount will be billed to you. If your insurance company pays in full, you may not receive a statement. Refer to the "explanation of benefits" from your insurance carrier.
Q. I received a statement, but all it shows are totals. Can I have an itemized bill?
Q. How do I know that the amount you are billing me is the correct amount?
A. Once your insurance carrier pays its portion of the bill, they will send you an explanation of benefits (EOB) to show how the claim was paid. You can compare your EOBs (both professional and technical EOB) to your hospital statement. How the carrier paid the claim is based on its contract with the hospital and its contract with you. If you feel the insurance company should have paid a higher amount, please contact the insurance company directly for resolution.
Q. My hospital statement had an adjustment amount. What was that for?
A. Insurance carriers negotiate hospital charge discounts. The amount of the discount is specific to each carrier. When the carrier pays its portion, the contractual allowance is posted to reflect the true amount due from the patient. Contractual adjustment can be either a deduction or addition to the amount of actual charges billed.
Q. My account has been referred to an outside collection agency. Can I view my statement?
A. If your account has been referred to an outside collection agency, you must contact that agency.
Q. What is the difference between an observation and inpatient category on my bill?
A. Your physician determines whether you will be categorized as observation or inpatient. Insurance plans pay differently for each category. The hospital must abide by the physician order and bill accordingly. Your status can change based on your clinical conditions and results from diagnostic tests (according to the physician’s order) to inpatient usually within 24 hours if an inpatient stay is necessary. Other factors used include the level of care required which is based on the severity of the illness and the intensity of service required for treatment.
Q. Can I add or change the insurance on my account?
A. Yes, but if you are adding a managed care plan or HMO coverage that had mandatory pre-certification requirements this coverage cannot be add and billed after the fact.
Q, How do I request a change of address?
Q. Should I bring my insurance card with me to the hospital?
A. Yes. The information on your insurance card is needed to file a claim with your insurance company or companies. When you register you will be asked for information about your insurance coverage. Additionally, you will be asked to sign related forms. The registration process goes faster when you bring your insurance information with you.
Q. Will the hospital file my insurance claim for my current visit?
A. Yes. The hospital will continue to submit claims to your insurance company for you. As insurance companies require more information, however, the accuracy of your records is extremely important.
Q. My claim was denied. Can I request the hospital resubmit my claim information to my insurance company?
A. Typically Patient Financial Services has already attempted to get a denial reversed, and the insurance plan has denied payment. In some special circumstances, rebilling may be warranted.
Q. I gave my insurance information to my physician, why don't you have it?
A. If your physician’s medical practice is not owned by the hospital, you will have to go through a separate registration process. Your benefit coverage may be different for physician services than it is for hospital services. If your physician’s office is a department of the hospital all information will be shared between the physician practice and the hospital.
Q. Even though I gave my medical insurance, I was later asked for my automobile insurance because my injury was due to an automobile accident. My medical insurance will cover the bill, so why is any other insurance needed?
A. When we bill your medical insurance for treatment related to an accident, the carrier will want to know if there is any other insurance that may be liable for the bill and generally the hospital must bill the liability carrier first. If the hospital cannot provide the information at the time of billing, the claim may be delayed, or even denied, until the information is given.
Q. How do I follow-up with my insurance company?
A. Most insurance company identification cards include a customer service telephone number. Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Write down the name of the person you talked to at the insurance company. If the bill has not been paid, find out when the anticipated payment date is, and ask what is needed. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor.
Other key questions you should ask the insurance company customer service representative include the following:
- Have you received the hospital’s bill for these services?
- Am I covered for these services?
- When will you pay the hospital for these services?
- What portion of this bill will I be responsible for paying?
- What is the status of the account? If paid, ask when and to whom.
Q. Do I need to let my insurance company know that I'm going to be in the hospital? And what will they cover?
A. We encourage you to check with your insurance company or employer regarding coverage. There are many types of insurance plans, and we do not know if you need prior approval or notification for your hospital stay. Contact your insurance company or employer about what is or is not covered by your plan.
Q. Why didn't my insurance cover some services?
A. Insurance policies vary on services that are allowed (paid). Your particular policy may not cover a certain service or you may not have met your policy's deductible and/or co-insurance.
Q. My newborn roomed in with me, (never left my room), why is there a nursery charge?
A. The nursery room charge includes routine newborn supplies, food and nursing care. The charge is not entirely for the physical bed location.
Q. How do I know if my insurance company will cover services provided by all professionals (i.e. anesthesiologists, radiologists and pathologists) involved with my treatment?
A. Check with your insurance company or employer. Each professional contracts individually with insurance companies and the hospital does not know if each professional is contracted with your insurance company.
Q. How will I know if my insurance company has paid my bill?
A. When your insurance company pays your claim, it will issue you an explanation of benefit (EOB) notice regarding the payment action taken by the plan. If there is a balance due from you after the insurance company has paid its portion, we will send you a statement. This statement should agree with the amount reported to you from your EOB(s) and any balance you are required to pay.
Q. What can I do if I disagree with how much my insurance company has paid on my bill?
A. To better understand the insurance payment, feel free to contact Customer Service or contact your insurance carrier directly.
Q. When do I become responsible for my bill?
A. You are legally responsible for your bill at the time you receive hospital services. The hospital requires all patient balances be paid, or acceptable payment arrangements made, upon receipt of your bill.
Q: Are there payment options?
A. PeaceHealth offers payment plans up to 12 equal payments, depending upon the balance due. If you have a larger balance, we can offer long-term payments through a vendor. We also offer automatic payments that can be set up through your credit card or echeck. Please contact Customer Service
to make arrangements.
Q. How will I know what portion of the bill I should pay?
A. The amount you owe can be found in the box in the top right-hand corner of your bill. Your first bill should identify the total charges, the amount submitted to insurance, and the amount you owe. If insurance has paid part of your claim, the statement will identify the amount paid by insurance and the amount you owe. The "explanation of benefits" from your insurance company will also indicate which charges you are responsible for.
Q. What forms of payment do you accept?
Find out more about Payment Options. We offer several methods of payment including:
• We accept Visa, MasterCard, Discover and American Express. You may also pay by cash, check or money order.
• You can pay your bill online using one of the above credit cards or eCheck.
• You can also mail in your payment. Make check or money order payable to PeaceHealth. Please include your account number. Mail the payment to the address included on your statement.
• You may also call our Customer Service Department
to make your payment over the phone.
Q. What is a deductible or co-payment?
A. A deductible is the initial amount that you must pay before your insurance plan begins to pay for your bills. Typically, a deductible is a flat dollar amount (e.g. $1,000; $2,500; $5,000 or more. If you have a $1,000 deductible, you insurance company should pay all of the covered charges EXCEPT the first $1,000, which is your responsibility to pay.
A co-payment is a flat amount paid for each visit to a provider. If you have a $100 hospital co-payment, you must pay $100 for each service and your insurance company will pay for the remaining balance on all covered services.
Q. Do I have to pay my co-payment at the time of service?
A. Yes. You are expected to pay your estimated co-payment when services are provided.
Q. What is a Medicare explanation of benefits form?
A. The explanation of benefits form is an information document that Medicare sends to you after it has processed your medical claims. The explanation of benefits form provides you with information about the payment status of your bill.
Q. What is the difference between part A and part B explanation of benefits forms?
A. Part A covers inpatient hospitalization and part B covers outpatient hospital and physician services.
Q. What should I do with the explanation of benefits form?
A. Keep the forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the explanation of benefits from you before it will pay any remaining balance on your account.
Q. Will Medicare cover my outpatient procedure?
A. Yes. Medicare will pay for medically necessary acute care services ordered by your physician. There are many things your Medicare benefits will not cover (screening exam, preventive medicine services) and many services that must meet medical necessity screening, and the diagnostic reason stated by your physician. In some cases you may be required to sign an advanced beneficiary notice indicating that you have been informed that Medicare will not cover the costs of certain services. Self Administrable medications do not require a signed advanced beneficiary notice.
Q. Do I have to sign any forms before the hospital can bill Medicare?
A. You will be asked to sign a consent for treatment form each time you receive services. You will also be asked questions each time you receive services that Medicare requires.
Q. I have health insurance in addition to Medicare coverage. Will the hospital bill that insurance company also?
A. Yes. Provide the information at registration about your additional health insurance and that insurance company will be billed after Medicare makes its payment.
Q. Should I pay the balance that is listed as "your total responsibility" on the explanation of benefits form?
A. No. You will receive a bill from the hospital and that should be the invoice to which you make your payment. Often there is more than one insurance and more than one EOB that could make up the final balance for which you will be responsible.
Q. Will I have to pay any money for my hospital visits?
A. As a Medicare patient, you could be responsible for some significant charges that are related to, co-insurance, deductible and non-covered charge amounts. If you do not have a secondary or supplemental insurance coverage, please contact Customer Service
if your medical bill is a financial hardship.
Q. Why am I being charged for the pills, inhaler, ointments, etc. that I normally take at home?
A. Medicare has never covered self-administered drugs if they are provided in an outpatient setting. As an excluded service the hospital must bill the beneficiary. If you have a Medicare Part D/Medco plan, please contact Customer Service, they can mail you the information you will need to file a claim with your Part D insurance carrier.
Part D insurance carriers, will not pay the hospital directly, they will only reimburse you for what you have paid the hospital.
To reach Customer Service for additional information, see Contact Us
Q. I was admitted to the hospital on one day but there are charges on the detail bill for a few days prior. Why?
A. Medicare has a 72 hour rule that requires that the billing of outpatient services rendered just prior to an inpatient stay must be included on the inpatient bill.