Patients

Your physician and the hospital staff will be in contact with your insurance company upon your admission and periodically throughout your stay, if applicable.

Hospital Credit Policy

If you have questions concerning your health insurance, are in need of financial counseling, or have questions about insurance coverage, please contact Patient Accounting at Ext. 3034. It is necessary to finalize all insurance arrangements before discharge.

Outpatient Treatment

Pre-authorization and/or a referral form are required for payment by many insurance companies for outpatient procedures and testing. A physician’s order with an appropriate diagnosis is required for laboratory  reimbursement. Please check with your physician and/or insurance  company for these requirements.
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Understanding Health Insurance Requirements

In the past, health insurance plans were very similar. Today, however, there are many different types of health insurance plans, along with new requirements that the patient and physician must follow to avoid unnecessary delays and expenses in seeking treatment. It is important for everyone covered by a health insurance plan to know what the plan covers and what is required for multiple phases of healthcare, especially for:

What Steps Must Be Taken To Verify Your Coverage By Your Insurance Company?

It is necessary for you to read and understand your insurance benefits booklet for information specific to your situation. Common insurance company requirements are:

Diagnosis - The prescription from your doctor must include a diagnosis to justify tests, surgery, and laboratory work.

Referral - Your primary care doctor must refer you to a specialist or acknowledge   the medical need for the care that has been ordered when he/she feels your situation requires specialist care.

Authorization Number - Your family doctor or sometimes the specialist caring for you (depending on the insurance company rules) must call the insurance company for authorization to send you for tests or outpatient surgery. If the insurance company approves the medical necessity of these tests/procedures, your physician will be given an authorization number. This number will then be shared with the hospital.
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How Does Your Health Insurance Affect You When The Doctor Orders A New Medication For You?

Many health plans have a formulary, a list of approved medications for which they will pay. Your physician must abide by this list, unless he/she can medically justify that your condition requires a medication not in the insurance company’s formulary. This can be frustrating and time consuming for you, your doctor, and the doctor’s staff.

How Does Your Health Insurance Affect You When You Require Emergency Care?

Many health plans require that the patient notify his/her doctor before going to the Emergency Department. Your doctor must send approval of your emergency care to the insurance company and the hospital within a specified time frame.
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How Does Your Health Insurance Affect You If You Need To Be Admitted To?

If you are sent from the physician’s office, his/her office staff must call for authorization from the insurance company before sending you to the hospital. If you are admitted from the Emergency Department, the hospital must call the   insurance company for authorization to admit you to the hospital. During your stay, the hospital staff must call the insurance company on a regular basis to justify the medical necessity of your continued care in an acute care hospital setting.

Occasionally, the health insurance company decides a patient no longer should be in the hospital, and the insurance company will “deny” part or all of the stay in the hospital. If this happens, the hospital staff will notify your doctor. Your doctor will often choose to speak with the physician at the insurance company. If these physicians cannot agree upon the medical necessity of your care, the insurance company will “deny” payment for all or part of your stay. If this happens, the hospital will appeal this decision with the insurance company with your permission.
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How Can You Protect Yourself And Your Family As Consumers Of Healthcare?

1. Be well informed, and read your insurance benefits booklet.

2. Make sure that you have the necessary paperwork and/or authorization numbers before coming to the hospital for outpatient care.

3. Call the 800 number in your insurance booklet if you have questions about your benefits.

4. Ask your employer to help you if you continue to have questions or concerns regarding your health insurance plan.

5. Call the 800 number if you receive a copy of a bill where payment was denied to find out the reason.

6. Know your rights as a patient and a subscriber. (You have special rights under your health insurance plan. Often your employer can help you.)

7. Ask your doctor’s office how your insurance plan is affecting your care.

8. Carry your current insurance cards only with you at all times.
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