Paying for Healthcare: Lock Haven Hospital Is Here To Help
By Kristin Sykes
Assistant Chief Financial Officer
Every day we are bombarded by headlines about the difficult economic times that we are currently facing. While there are hopeful economic signs on the horizon, many of us are still faced with the reality of making difficult choices when it comes to our own healthcare and that of our families.
Paying for healthcare can be a confusing and frustrating process for patients and their families. Lock Haven Hospital offers a number of options to assist patients with paying for healthcare including payment options, payment plans and financial counseling.
To help you better understand the process, here are some of the commonly asked questions addressed by the Lock Haven Hospital business office.
Will the hospital bill my insurance?
The Lock Haven Hospital business office will bill both primary and secondary insurance carriers. There are a variety of plans and networks in existence, so it is important to furnish complete and accurate insurance information in order to expedite prompt payment. Always carry your insurance card(s) and identification with you each time you visit the hospital or doctors office.
Will my insurance pay for everything?
There are many different types of insurance plans with a variety of coverage options. Typical patient charges include co-pays and deductibles. These patient charges are applicable even though the Hospital or doctors office may have a contract with your insurance carrier. As a routine practice, the hospital asks for payment of any deductibles and an estimated co-insurance deposit prior to delivery of services at pre-registration or at the time of registration in the hospital. If you do not have any insurance coverage or you cannot afford to pay these fees in advance, you can discuss payment arrangements and options with the hospital’s financial counselor. You can reach the financial counselor at 570-893-5448.
How do I know the insurance carrier has received a bill from the Hospital?
If your carrier does not process the claim within 30 to 45 days, you will receive an invoice from the Hospital. We suggest you contact your insurance carrier if you have any questions regarding payment of the bill. Encourage them to pay the claim promptly on your behalf. Ultimately, you are responsible for those charges unpaid by your insurance carrier
How will I know the status of my account?
You, or the responsible guarantor, will receive statements indicating the status of your account, including any credits for payments you have made, contractual adjustments (the payment that the hospital accepts based on contracts with insurance companies) and/or insurance payments.
If I have a concern with my bill, who do I call?
If you receive your bill and are confused by terminology or have questions or concerns about paying the bill, you may contact the Lock Haven Hospital Financial Counselor at 570-893-5448 between the hours of 8:30 AM and 4:30 PM, Monday through Friday, or visit the Patient Access Director personally, located on the first floor, the Main lobby area. Our goal is to ensure that we answer all of your questions about your bill and that you are very satisfied with the experience.
Medical Assistance
Patients without insurance or self-pay patients may qualify for state funded medical assistance. Lock Haven Hospital contracts with Healthcare Receivables Specialist Inc. (HRSI) to assist self-patients with the medical assistance application process.
Self-pay and uninsured patients will be contacted by an HRSI representative to discuss the process of applying for medical assistance. Many patients are confused about the process and who would qualify for medical assistance. The HRSI representative can guide patients through the application process, can perform a preliminary screening and answer any questions about the qualification process. The HRSI representative is available Monday – Friday from 8:30 AM to 5:00 PM and can be contacted at 570-893-5332
Helpful Tip
Keeping track of the bills sent by various health care professionals and facilities, as well as the information sent to you by your insurance carrier, can be a challenge. We suggest you keep these records in a separate file, noting the dates of service and payments made for those services. Keeping records in one place will be helpful in resolving billing questions and may also come in handy when it comes time to file your income tax return.
Physician Bills
In addition to the Hospital’s bill, you may receive separate bills from your personal physician, radiologist, anesthesiologist, emergency room physician and other consultants or specialists that your primary care physician chooses to involve in your care. They will bill you directly for their services. Any questions regarding these bills should be directed to those providers.
The Hospital cannot control which insurance plans are accepted by the physicians who provide services at Lock Haven Hospital. Therefore, you should discuss with your personal physician, whether he/she can include in your care, only physicians who accept your insurance plans. Otherwise, you may incur additional out-of-network, co-insurance expenses.
Here To Help
There are a variety of resources and help available free of charge and only a phone call away at Lock Haven Hospital:
· Financial Counselor – 570-893-5448
· Patient Access Director – 570-893-5130
· HRSI – 570-893-5332
About the author: Kristin Sykes is the Assistant Chief Financial Officer, Lock Haven Hospital.
Healthcare Terminology
Understanding your hospital bill
Terminology used to describe various aspects of a hospital bill can be confusing. Here are some terms used frequently by Lock Haven Hospital and most health insurance carriers:
Co-insurance:
The amount you are required to pay for medical care after you have met your deductible. This rate is usually expressed as a percentage of covered charges, i.e. 20%.
Coordination of Benefits (COB):
COB eliminates the duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100 percent of the billed charges. Many insurance companies will not process claims until they have COB information on file. Should your carrier request this information, please respond immediately.
Co-payment (Co-pays):
Flat fee you pay every time you receive service. Most insurance companies have co-pays for physician visits and emergency room visits.
Contractual Adjustments:
The difference between hospital charges and what the hospital is contractually obligated to accept as payment from the insurance company.
Deductible:
The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts to pay.
Explanation of Benefits (EOB):
A form sent to you by your insurance carrier. It explains the amount of total hospital charges covered by your policy, the amount of payment made and to whom, and any deductibles or co-insurance.
Guarantor:
The individual financially responsible for payment of an account.
Health Maintenance Organization (HMO):
Prepaid health plans. You pay a monthly premium and the HMO covers the cost of your physician visits, hospital services, etc. You must use the physicians and hospitals designated by the HMO.
Inpatient (IP):
This refers to charges relating to an inpatient (or in hospital) admission.
Medicare Advantage Plan:
A replacement plan for traditional Medicare.
Medicare Carrier:
The company that processes Part B physician claims.
Medicare Intermediary:
The insurance company the federal government contracts with to administer the Medicare Program.
Out-of-Network:
This refers to physicians and healthcare service providers who are not included in your insurer’s network of member providers. Using out-of-network providers may result in higher or additional co-insurance payments.
Outpatient (OP):
This refers to charges relating to outpatient testing and/or outpatient surgery.
Preferred Provider Organization (PPO):
A combination of traditional fee-for-service insurance and an HMO. When you use the physicians and hospitals that are part of the PPO network, your medical and hospital bills are covered. However, you have the option of using physicians outside the network, but at an additional cost to you.
Pre-existing Condition:
Health condition that existed before the date your insurance became effective. Many insurance plans will not cover care related to pre-existing conditions. Some will cover them only after a waiting period.
Primary Care Physician (PCP):
Family physician who monitors your health and diagnoses and treats any conditions or illnesses. Your PCP may refer you to a specialist if another level of care is needed. If you have an HMO, your PCP must authorize all services, including ER services.
Reasonable and Customary:
A fee some insurance carriers pay for a particular service. If your physician or hospital charges more than the reasonable and customary amount, you may be responsible for the difference.
Self-pay patients
Patients without health insurance coverage or those who choose to pay directly for their healthcare are described as self-pay patients.
Universal Billing Form (UB04):
Standard billing form required by Medicare and most insurance carriers to summarize a patient’s hospital charges.