Patient Accounting
1. Please explain the registration process. Must I register each time?
Yes, every visit must be set up as a new encounter at the medical center. This is necessary for an accurate record of all your visits to the medical center kept in our Medical Records Department. In addition, there are many billing and insurance requirements that mandate a new registration for each visit. There are some exceptions which we call Recurring Patients. This includes such things as repeated physical therapy visits, and frequently repeated lab tests during the month.
2. I belong to a managed care plan. What should I do before my scheduled visit or inpatient admission.
Almost all Managed care plans require an authorization prior to having the services received at the medical center. You should definitely check with your MCO to notify them of your upcoming service. The medical center attempts to contact your MCO on your behalf on outpatient visits. For Admissions, we will contact your insurance company and obtain all required authorizations.
3. I belong to a managed care plan but needed help in an emergency. What should I do now that I’ve received services?
For emergency services, MCO’s are forbidden by Federal law to prevent you from having necessary screening tests and stabilizing treatment prior to notifying them. However, they may require you to notify them of the Emergency services received within 24 hours of the treatment. You should notify them of the visit when you are stable and able to make the call.
4. How and when do I know what I owe? What if I have two insurance carriers?
Our Business Office will submit your bill to all insurances we have received information about during the Registration process. We will submit the bill to any secondary insurance once we have received payment or denial from the primary. Once we have received payment or denial from all insurances listed, we will send a summarized statement to you showing your charges and any payments and/or adjustments. Once you receive this first statement from us, if you pay promptly and in full, you will receive a 15% discount. You may call our office at any time to inquire about your balance or the status of your insurance claim at 740-439-8140.
5. What items are included in your charges?
Your medical center bill will detail every item used in your care and treatment. It includes any room and board charges, pharmacy, lab, xrays, supplies, surgery and Emergency room charges to name a few. Your bill will not include any professional fees such as your ER doctor bill, Xray interpretation, Pathology studies, or Anesthesiologist bills. You will be billed directly by these physician offices.
6. Can you tell me what the total charges will be before I receive services?
Yes, for most services. We can tell you the charge for any individual test or supply. It is more difficult to determine complete charges for particular operations or complicated procedures. However, if you need this type of information, generate reports that help us determine the “average” charges that were incurred by other patients that had the same type of service. Contact our Business Office for any price information you need.
7. How does your contractual agreement with my insurance company affect the billing process?
At the time the payment is received in our office from the insurance company, our cashier deducts any adjustment indicated by your insurance company on the payment transmittal. Sometimes these are very difficult to see and an adjustment may be missed that you feel you were entitled to. If that happens, simply call our office and we’ll investigate.
8. I don’t have any insurance. Is there any help available?
Perhaps. For those who request assistance on Inpatient bills, we submit a referral to the local County Department of Human Services. Some patients are eligible for Medicaid. There is also a program known as “Care Assurance” that is solely based on income. We also have a special hospital charity care program with higher income guidelines. Our hospital has trained professionals who are happy to assist you in applying for potential public assistance for which you may be eligible. Contact our financial assistance office at 740-439-8646 for more information. We also offer 15% discounts for payment in full in a lump sum settlement.
9. I have insurance, but don’t have much money and have many medical expenses. Is there any help available for the balance I owe after my insurance?
We would recommend speaking with our financial counselor. You may qualify for Ohio’s Care Assurance program, the SEORMC Charity program, or you may wish to discuss a possible lump sum settlement.
10. Can I set up a payment plan for my portion of the bill?
Yes. While we certainly prefer payment of the balance in full, when it is necessary, payment plans can be provided.
11. Does Medicare cover everything?
No. This is a very complex area and you should contact our professional office staff for answers to your specific questions. Their number is 740-439-8140. Medicare also does not cover self-administered drugs given to outpatients. Many diagnostic tests must meet medical necessity criteria. Your doctor can tell you if Medicare considers the test medically necessary and therefore covered by Medicare.
12. I have been a patient at SEORMC many times so I receive multiple bills. It gets confusing trying to keep up with everything. Can I get only one statement?
Unfortunately this is not usually the case. Sometimes, remaining balances after insurance can be combined to one account, but often that is not practical.
13. Why can’t all the bills – medical center and doctors – be on one form?
For the same reason that your electric bill and phone bill are separate. They come from two completely different providers of service. medical centers and doctors file insurance claims on completely different forms and sometimes to different insurance offices. The fees charged by the doctors are not related to the medical center bill and would be an invasion of privacy to be included on medical center records.
14. I am having some therapy services for an extended period of time. How does the billing process work in this circumstance?
Visits such as this are generally set up as “recurring” or “series” accounts. This way, you register one time and that registration is good until the therapy services are completed. The medical center submits billing statements to you or your insurance on a calendar monthly basis. Each month’s bill becomes a separate account for billing purposes.
15. I am having a baby. What do I need to do to be sure my baby’s account is covered?
The easiest thing to do is check directly with your insurance company representative, or your employer’s health care administrator. They should be able to advise you on the procedure of adding your newborn to the insurance coverage. For those on Medicaid, you must contact your caseworker to have the newborn added to the case.
