Hospital charges do not include physicians' fees. You will be billed separately for the professional services of the emergency room physicians, your admitting physician and other physicians involved in consultation. For example, radiologists will bill you for interpretation of x-ray procedures; anesthesiologists will bill you for the administration of anesthesia during surgery; pathologists will bill you for their services. You are responsible for providing insurance information to those other providers. Sitters must also be paid separately.
Filing your Insurance
Your insurance will be filed as a courtesy. State law allows 45 days for payment. At that time, you will receive a statement for any unpaid amount reflected in the "Please Pay" box on the statement.
Important information for Medicare outpatients
Mosaic Life Carestrives to provide quality health care services and act in the best interests of our patients. We want to ensure the smooth delivery of services during your outpatient visit and inform you of any procedure/test that may not be covered by your insurance plan.
Based on these values, we will make sure that the physician's prescription contains the outpatient test/procedure code(s) and a diagnosis. These procedure codes are used by Medicare to determine coverage. If the test/procedure passes Medicare standards, you will be registered in our system and then proceed to the clinical department to have the tests/procedures performed. If some or all of the tests/procedures ordered by your physician do not meet Medicare standards, you will be asked to review and sign an Advanced Beneficiary Notice (ABN) form. By signing this form, the patient agrees to be personally and fully responsible for payment if Medicare denies the claim. There may also be times when the physician's prescription may be missing critical information such as the procedure and/or diagnosis codes. Medicare will not cover the service without this information. If this occurs, our Access department will contact your doctor's office and try to obtain the correct information so that we can ensure that it will meet Medicare standards.
What is an Advance Beneficiary Notice (ABN)?
The ABN helps you to make an informed consumer decision about whether to obtain the health care services and be prepared to pay for it, either out of your own pocket or by your other insurance coverage or you can choose not to receive the services. Each Medicare patient/guarantor must decide whether or not to have the tests/procedures performed when a specific test/procedure fails Medicare standards.
If you decide to receive the health care services, the hospital will send the claim to Medicare. If Medicare denies payment, you are personally and fully responsible for payment.
The Medicare patient/guarantor also have the right to appeal Medicare's decision.
If a Medicare patient/guarantor decides not to have the tests/procedures done, no claim will be sent to Medicare.
The ABN is a written notice that a Medicare patient may receive from the hospital before a test/procedure is rendered. The ABN notifies you that Medicare will probably deny payment for that specific health care service and specifically list the reason why the hospital expects Medicare to deny payment along with the price of the test/procedure. If you decide to receive the health care service and be personally responsible for payment if Medicare denies payment, a Medicare patient will receive a copy of the ABN for your personal records.