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Find answers to frequently asked billing questions.
Bills for services rendered are sent after insurance has processed.
You can get this information by talking with our estimates team at (844) 212-1049.
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.
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 .
Yes. The primary, and if applicable secondary, insurance coverage you present at the time of registration will be billed.
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.
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.
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.
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.
If your account has been referred to an outside collection agency, you must contact that agency.
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.
Yes, but if you are adding a managed care plan or HMO coverage that had mandatory pre-certification requirements this coverage cannot be added and billed after the fact.
You can send a message to a Customer Service Representative from your MyPeaceHealth account by choosing "Ask a Question" from the Messaging tab drop down menu once you have logged in. Next, you would click the Billing Questions button.
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.
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.
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.
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.
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.
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.
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.
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.
The nursery room charge includes routine newborn supplies, food and nursing care. The charge is not entirely for the physical bed location.
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.
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.
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.
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. Please contact Customer Service to make arrangements.
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.
We offer several methods of payment including:
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.
Yes. You are expected to pay your estimated co-payment when services are provided.
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.
Part A covers inpatient hospitalization and part B covers outpatient hospital and physician services.
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.
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.
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.
Yes. Provide the information at registration about your additional health insurance and that insurance company will be billed after Medicare makes its payment.
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.
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.
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.
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.
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