Q: What is a PCP?
A: A Primary Care Physician (PCP) is a doctor who will provide and coordinate all of your medical care. PCP's have specialties in:
Q: Do I have a pre-certified, prior authorization or referral requirement?
A: Many health insurance plans have pre-certification or prior authorization requirements for specific services. Please refer to the back of your health care insurance card, your benefits handbook, or contact the benefits representative at your place of employment. Some important items to remember when obtaining an authorization or referrals:
Q: Do I have to pay my co-payment at the time of registration?
A: Yes, you are expected to pay your co-payment when you register. Your insurance card should indicate the dollar amount of the co-payment required for each type of service. If you have any questions regarding co-payment amounts, you should contact your insurance company or your employer
Q: How Can I Pay My Patient Balance?
A: We offer the following payment options:
Q: How do I follow up with my insurance company?
A: If your claim has not been paid and you are receiving dunning notices from us, you should make a follow-up phone call to the insurance company.
Before making the call to the insurance company, have your insurance card handy, date of service, facility name, original amount billed, patient name, and claim number if applicable.
Make sure you understand the exact status of your claim. If paid, ask when and to whom. Note this information and the name and telephone number of the person you spoke to.
If the bill has not been paid find out when the anticipated time frame for payment is, and ask if they have everything they need to process the claims. If the insurance company is requesting additional information to process the claim, please obtain a fax number for the hospital's use.
If the bill has not been paid by the stated time frame, you should follow up with the insurance company again, and if necessary, request to speak to a supervisor.
Q: How will I know if my insurance company has paid my bill?
A: Your insurance company is responsible for sending you an explanation of benefits (EOB) when it pays your hospital bill. If you have any questions regarding any information on the EOB, please call YOUR INSURANCE COMPANY for details.
If your insurance company pays your account in full, you will not receive a bill from us unless you specifically request a copy.
If our records indicate that you have a balance after your insurance pays, you will receive a statement indicating your account balance after we have completed processing the payment.
Q: Should I bring my insurance card with me to the hospital?
A: Yes, the information on your insurance card is needed for the hospital to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign some forms. You will also be asked to provide a valid form of identification. Copies will be made of your insurance card and your identification.
You should also be aware that you insurance card contains very important information about the co-pay amounts you are responsible for on different types of service. Please be sure to review this information prior to your trip to the hospital, if possible. If your insurance card does not provide a billing address, please obtain a correct address before you come to the hospital. This will avoid any delays in billing your claim.
Remember, the registration process goes much faster when you bring complete insurance information with you.
Q: What if I get more than one bill?
A:You may receive more than one bill for the same date of service. In addition to hospital charges, you may receive bills for services provided by physicians such as emergency room doctors, anesthesiologists, radiologists, pathologists, cardiologists, or other professional medical groups.
Unfortunately, we are unable to assist you with billing questions regarding physician bills. If you wish to discuss a bill that you have received from one of these physician groups, please call the phone number indicated on the bill for assistance.
Q: When do I become responsible for my bill?
A:You are legally responsible for your bill at the time you receive services from the hospital. YOU are ultimately responsible for insuring that the hospital is reimbursed for the services that we provided to YOU.
Q: Will you bill my insurance company for me?
A: Yes, we will bill your insurance company for you, provided you have given us complete insurance information, including the name of the company, the address to which claims are to be billed, your policy identification number, your group number (if applicable), and a phone number. It is your responsibility to provide any required information (referrals, authorization numbers, claim forms, accident information). It is also your responsibility to follow the rules of your insurance company regarding pre-certification and second opinions.
We will bill your secondary insurance provided you have given us complete insurance information as noted above.
Q: How is a charge set for my services?
A:The health care industry became deregulated in 1992. This means that our previous all payor system whereby everyone shared in non-reimbursable costs such as uncompensated care was eliminated. Indemnity insurers, HMO's, and other managed care providers now compete to obtain provider contracts. Few payors contribute their fair share of these non-reimbursable costs. We are forced to raise our charges at a rate much higher than external inflation trends to cover these expenses.
We base our charges on Medicare's fee schedules and then apply a mark up factor to achieve this. In addition, charges in a hospital emergency room setting are high because we must staff and equip for critical emergencies around the clock. Unfortunately, we are unable to assist you with billing questions regarding physician bills. If you wish to discuss a bill that you have received from one of these physician groups, please call the phone number indicated on the bill for assistance.
Q: What are the current Medicare deductibles?
Part A Deductible:
Part A Co-insurance:
$315.00 per day
Part A Lifetime Reserve Days
$630.00 per day
Part B Deductible
Q: What is a "Medical Necessity"?
A: Medicare covers only those services which are reasonable and necessary for your treatment. Medicare requires all providers to report information regarding the patient's diagnosis when seeking payment so that they can determine whether the services ordered were medically necessary.
Q: What is an ABN?
A: ABN is an Advance Beneficiary Notice, which we are required to provide to you by Medicare. The purpose of the ABN is to give you advance notice that Medicare may not pay for your services. The ABN tells you which test(s), based on Medicare guidelines, are not reasonable and necessary, and informs you that you will be financially responsible for the services. When it is required, you will be asked to sign the ABN before services are performed.
Meridian Health will advise your Physician that the diagnostic information he/she provided did not meet Medicare guidelines for the test ordered. The Physician may also supply additional information to our staff. However if no additional information is received, or the additional information does not meet Medicare guidelines you may be responsible for payment of the services after Medicare makes its final determination.
Q: Do I need the service if Medicare will not pay?
A: Your physician bases decisions on a wide range of factors including your personal medical history, any medications you might be taking and generally accepted medical practices. Even if your physician believes a particular test/service is "good medicine" and useful information to have in order to provide the best care for you, it is possible Medicare may not consider the service to be medically necessary for patients with your diagnosis.
Q: How Can I Get Additional Information about Medicare?
A: If you have questions, you should discuss them with your physician and/or health care provider at the time of service.
Additional information on ABN's, non-covered services and your rights as a Medicare Beneficiary is available on Medicare's Web site at: http://www.medicare.gov/.