Insurance

At Mosaic Life Care, we accept most insurances. The best way to know if your insurance is accepted by Mosaic Life Care is to call your health plan and confirm that we are included. Sometimes, we may be included in some, but not all, products that a health plan offers. Individual group contracts determine what is covered and is the reason it's best to always check with your insurance company for services and providers in network.

See a list of Health Plans with which we contract.

If you do not have insurance or need help knowing what options are available to you, our financial counselors are available to help. To schedule an appointment with one of our financial counselors, please call (816) 271-7524.

Glossary of Terms

Managed care

Refers to a broad and constantly changing array of health plans that attempt to manage the cost and quality of care. Ideally, managed care brings about a comprehensive healthcare system where you receive the care you need – including preventive care – when you need it and in the most cost-efficient manner possible. The three most common "managed" health insurance plan choices are: health maintenance organization, point of service, and preferred provider organization. You have another option, which is commonly called traditional, indemnity or fee-for-service insurance, as well.

Health maintenance organizations (HMOs)

HMOs emphasize prevention and offer a select choice of doctors and hospitals. You select a primary care doctor who coordinates all of your medical care including referrals to a specialist and hospital care, if necessary. You may also have minimal co-payments for office visits, allergy shots and other services. An HMO option is easier on your budget since you have minimal out of pocket and unexpected expenses – as long as you receive all medical care through the HMO.

Point of service plans (POS)

These plans are similar to HMOs, except there is an option to seek medical care from a specialist without needing a referral from your primary care doctor. In this case, you may have reduced benefit coverage, meaning you may have to pay more out-of-pocket costs to receive specialty care without a referral. If you pick a specialist or hospital that is on the plan's "preferred" list, you will usually have some co-insurance in addition to a co-payment. If you pick a specialist or hospital that is not "preferred" by the plan (or out-of-network), you will usually have higher co-insurance in addition to your co-payment. Most POS plans cover preventive care, as well.

Preferred provider organizations (PPOs)

PPOs have fewer restrictions in accessing providers than with other plans. You can pick any doctor, hospital or service you want. If the provider is "preferred" by the plan (in-network), you pay a lower co-payment and co-insurance – depending on your plan design. If you choose a doctor or hospital that is out-of-network, then you will have higher co-payments and co-insurance. You may also be billed for any amount charged that the plan does not consider reasonable. In other words, you may opt to use a PPO provider and receive maximum reimbursement and benefits or, seek medical care from a non-PPO provider and receive reduced reimbursement and benefits.

Traditional, or indemnity, insurance

This type of insurance may not cover preventive services; however, you may see any doctor or hospital because there is no network or plan list. With indemnity, you will pay an up-front deductible before there is any reimbursement by the insurance company. Typically, you must complete the claims paperwork. Usually, traditional or indemnity insurance is the most expensive option for health plan coverage.

Co-insurance

The amount plan members pay out-of-pocket for medical services. The payments usually constitute a fixed percentage of the total cost of a medical service covered by the plan; for example, if a plan pays 80 percent of a health bill, the patient pays the remaining 20 percent as co-insurance.

Deductible

The sum of money that an individual must pay out-of-pocket for medical services before the health plan pays its portion. Deductibles are usually per person, or per family, per calendar year; for example, an individual may have a $200 deductible whereas a family may have a $400 deductible.

Medicaid and Medicare

Medicaid is a program jointly-funded by the state and federal government to provide medical aid for people who are unable to finance their medical expenses.

Medicare is a federal health insurance program for older Americans and eligible disabled individuals.

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.

Preventive care

Preventive care is an approach to healthcare that emphasizes preventive measures and health screenings such as routine physicals, well-baby care, immunizations, diagnostic lab and X-ray tests, pap smears, mammograms and other early detection testing. The purpose of offering coverage for preventive care is to diagnose a problem early, when it is less costly to treat, rather than late in the stage of a disease when it is much more expensive, or too late, to treat.

Primary care doctor

These specialized doctors provide a full range of healthcare services to individuals and generally coordinate and manage the care of HMO patients. Family medicine doctors, general internal medicine doctors, and pediatricians are recognized by managed health plans as primary care doctors. Some HMOs recognize obstetrician/gynecologists as primary care doctors.

To Our Patients

For many patients and their families, a visit includes filling out unfamiliar forms and answering financial and insurance questions. The information below and the phone numbers that follow can help with this process.

Heartland Regional Medical Center (doing business as Mosaic Life Care) and all other Heartland Health controlled organizations will honor assignments of insurance benefits for 45 days from the date of billing to the insurance company.  If, at the end of 45 days, the insurance company has not settled the account, Mosaic Life Care will look to the patient for the final settlement of the account.

Any patient having inadequate insurance coverage, or no insurance coverage, will be requested to make appropriate deposits at the time of admission.

Your Insurance Identification (I.D.) Card

Medicare I.D. Cards

Starting in April 2018, Medicare is removing Social Security Numbers from Medicare cards and will begin sending out new cards with a new unique number for each person with Medicare.

This change is to help protect people with Medicare from identity theft and will not impact insurance coverage. New cards will be mailed out between April 2018 and April 2019. Once you get your new card, destroy your old one and start using your new card right away. Remember, bring your new card with you to your medical appointments.

To prepare for the new card, make sure your mailing address is up to date. If your address needs to be corrected, contact Social Security at ssa.gov/myaccount or call 1-800-772-1213. TTY users can call 1-800-325-0778.

Medicare will never ask you for personal or private information to get your new Medicare number so beware of anyone who contacts you for this reason.

See the new card and learn more.

Insurance I.D. Cards

To enable Mosaic Life Care to bill your insurance company directly, you will be asked to provide your insurance identification (I.D.) card(s). In the event of a true emergency, the card should be presented as soon as possible following admission. You will also be asked to provide any claim or referral forms required by your insurance company.

Mosaic Life Care at St. Joseph - Medical Center is a participating hospital provider in numerous major managed care organizations.

Note: Failure to provide accurate and current insurance information and required referrals when you are admitted could result in penalties or a reduction of benefits by your insurance company.

Your insurance and Medicaid coverage

There may be some services or supplies your insurance will not pay for. Should this occur, you will be billed directly. To apply for Missouri Medicaid, please contact a representative at (816) 271-7524.

340B Program

The 340B program was created in 1992 to expand access to affordable medications to low–income populations. It allows hospitals, such as Mosaic Life Care at St. Joseph - Medical Center, to purchase prescription drugs at a substantially lower price, passing that savings along to low–income patients who can receive prescriptions at a discounted price. You have the right to choose the pharmacy of your choice. 

To be an eligible patient of Mosaic Life Care’s 340B program a patient must:

  • See a provider that is either employed with, contracted with or referred from Mosaic Life Care AND
  • Mosaic Life Care must have record of care (i.e. medical record) AND
  • The prescriber must be in Mosaic Life Care at St. Joseph - Medical Center or a facility (i.e. child site) that is 340B eligible.

If you wish to transfer any of your prescriptions to a 340B participating pharmacy, please contact your Mosaic Life Care provider.

Pre-certification

Most insurance companies require pre-certification, or approval of admission before a scheduled hospital stay and various outpatient exams. It is the admitting physician's responsibility to contact a patient's insurance company to complete those requirements before service. Ultimately, you are responsible to notify your insurance company before arriving.

Emergency admissions must be "pre-certified" by contacting your insurance company as soon as possible (usually within 24 hours).

Note: Failure on your part to pre-certify with your insurance company could result in a reduction of benefits, or in some instances, a denial of payment by your insurance company for your hospital stay.

Benefits

Many insurance companies limit the number of days of hospitalization that they will cover, and may limit certain hospital services. Please contact your insurance company for complete information about your benefits and coverage.

Second Surgical Opinions

Many insurance companies require a second surgical opinion prior to approving surgery. Please check your insurance policy to determine if this is required.

Discharge Planning

Discharge planning often begins when you are admitted. During your hospital stay, your care is monitored by a nurse case manager and, when indicated, by a social worker from Care Management. The case manager maintains contact with your insurance company to review your plan of care and assess your needs. The social worker will assist you in planning your discharge and arranging any post-discharge needs that you may have.

Medical Necessity

This term refers to those services, as defined by your insurance company, that are medically appropriate in a hospital setting. Your insurance company may determine that some or all of the services that you receive during your hospital stay are not "medically necessary." Should this occur, you should receive notification from your insurance company that these services may not be payable by your plan, as well as a letter from Mosaic Life Care outlining your financial responsibilities for these services.

Denials and Appeals

Mosaic Life Care maintains an Appeals process to review non-coverage decisions related to your visit. Patients continue to remain responsible for deductibles, co-insurances or other charges outlined in your health care insurance policy.

Financial Assistance

For patients who are unable to pay the full amount, Mosaic Life Care has a program that may help pay the healthcare services. Applicants will be evaluated for possible Medicaid eligibility and may be required to formally apply through the Division of Family Services for Missouri Medicaid or contact a HCFS representative at (816) 271-7036. An application for Financial Assistance can be made with Patient Financial Services by calling (844) 261-7266.

To request an itemized bill (detailed charges)

Visit our online bill site at https://mosaic.simpleepay.com or at the patients request, Mosaic Life Care will provide an itemized bill. Please call Patient Financial Services at (844) 261-7266.

If You Have Questions

If you have further questions, please do not hesitate to call any of the following departments for assistance.

Pre-Registration
(816) 271-6579 or (800) 447-6827
Monday - Friday, 8 a.m. - 5:30 p.m.

Pre-Certification
(816) 271-6642
Monday - Friday, 8 a.m. - 5 p.m.

Patient Billing
Hospital and Clinic Billing: (844) 261-7266
Monday - Thursday, 8 a.m. - 7 p.m.
Friday, 8 a.m. - 6 p.m.
Saturday, 9 a.m. - 1 p.m.