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Health insurance billing
As a courtesy to you, HealthEast Care System will bill your insurance company, provided that you submit all the necessary information. You are responsible for any portion of your charges remaining unpaid by your insurance company. This includes non-covered services and any patient responsibility. Most insurance companies require patients to pay a portion of their doctor’s bill or hospitalization costs. The patient’s responsibility can be described as a co-payment, co-insurance or deductible.
You will be asked to pay your co-pay amounts prior to your appointment, procedure or admission. It is your responsibility to be aware of any exclusions, benefits, co-payments and deductibles outlined in your insurance plan. You may also be responsible for services rendered by other providers. These include anesthesiologists, radiologists and pathologists. We will share your billing information with those providers so that they can file a claim with your insurance company directly.
HealthEast Care System has designated its main campus and affiliate services as hospital outpatient departments. Patients will receive two separate bills: one for the health care provider, and the other to cover the costs of providing non-physician staff, equipment, and supplies. You may have a co-pay and/or a coinsurance amount depending on your benefits.
If you are scheduled for services, we encourage you to pre-register for those services. Preregistration will allow us to verify your insurance and benefit coverage, identify any financial responsibility you may have, and allow us to assist you in meeting your financial obligations.
During pre-registration, you will be asked to provide demographic and insurance information. Providing the correct information allows us to process your insurance claim quickly and accurately. Also, during the pre-registration or registration process you will be asked to pay any applicable co-pays.
On the day of your service, you will be checked in and promptly directed to your department for service. You will need to present your insurance card(s) at the time of service. The information on the card is important for correct identification of your insurance and in receiving the proper payment for your services. Your card will be scanned to ensure that the correct information is available for insurance processing.
Referrals and authorizations
Most managed care plans, Health Maintenance Organizations (HMOs) and Point of Service (POS) plans have referral and/or authorization requirements. Each plan is different, and it is your responsibility to know the requirements for your plan and obtain any necessary referrals. You may be responsible for payment or your appointment may be rescheduled if you do not obtain the necessary approvals.
Medicare requires that all tests have a supporting diagnosis to demonstrate the test is medically necessary. If your physician orders a procedure or service that does not support medical necessity, you will be asked to sign an Advanced Beneficiary Notice (ABN). The ABN informs you in advance that Medicare is not likely to pay for the procedure or service, and that you will be responsible for payment.
If you were recently covered by insurance under a group health plan, you may be eligible to pick up COBRA benefits to assist you with your medical bills. Our Financial Counselors or Financial Social Workers can assist you in determining if you might qualify for COBRA benefits.
If services you are requesting are the result of a work-related injury, HealthEast Care System will bill your employer or your employer’s liability carrier. You must provide us with the required information or we cannot bill the carrier and you will then be billed.
Out of network
Some health insurance plans restrict where you may receive your care. If you have services outside of your network, you may be responsible for higher out-of-pocket expenses or the entire bill. Check with your insurance company to ensure that your HealthEast Care System provider is in-network.