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Insurance Information

Patients are responsible for reporting any insurance changes to Mary Free Bed Rehabilitation Hospital.

Self-Pay Patient, Including the Uninsured
Medicaid Policies
Medicare Policies
Workers' Compensation
Blue Cross Policies
No-Fault Carriers
Other Insurance

Self-Pay Patients, Including the Uninsured

  • Patients without insurance coverage and who do not qualify for Community Financial Aid (charity care) will be reviewed by patient financial services.
  • Self-pay amounts qualify for a discount.This discount is calculated annually and approximates the overall discount paid by all payors.
  • Amounts owed for deductibles, co-payments, or other out-of-pocket expenses generally do not qualify for the discount. In cases of financial hardship, discounts for those amounts may be approved by the finance director or vice president of finance.
  • Exceptions may be made on a case-by-case basis.

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Medicaid, Medicaid HMO, and Children’s Specialty Health Care Services

Inpatient

  • For patients with active Medicaid, Medicaid HMO, or Children's Specialty Health Care Services (CSHCS) coverage, Patient Financial Services will bill accordingly. It’s the responsibility of the patient/guarantor to provide Mary Free Bed, prior to services, with the most current Medicaid, Medicaid HMO, or CSHCS information. If the patient has other insurance, Medicaid will not pay until the other insurance has paid or denied services, making it important to provide all insurance information.
  • For Medicaid HMOs requiring preauthorization of an inpatient admission, the admission will not occur until the pre-authorization is received.

Clinic

  • For clinic services, it’s the patient’s responsibility to obtain prior written authorization as required by Medicaid HMO plans for each scheduled service (for example, clinic evaluation, x-ray, physician) before receiving services. Any clinic services denied for non-compliance of prior authorization guidelines will be billed to the patient.

Outpatient

  • Prior authorization is required for outpatient speech, physical, and occupational therapy for all Medicaid patients treated over 144 units in a 12-month period. Medicaid HMOs require authorization for all services.
  • Services requiring prior authorization are scheduled after Patient Financial Services receives the approved prior authorization from Medicaid. Therapy evaluations do not require prior authorization, but are limited to 2 per therapy within a rolling 12-month period. Evaluations may be scheduled without delay.
  • Lymphedema and serial casting supplies are considered to be cash-and-carry items. Patients will be informed of their responsibility for payment of items prior to registration and during registration.
  • The following services are not covered by Medicaid, Medicaid HMO, or CSHCS: outpatient medical supplies, outpatient recreation, outpatient social services, outpatient nutritional services, drivers training, and inpatient and outpatient pool therapy. Prior to scheduling non-covered services, a Patient Financial Services representative will contact the patient to discuss self-pay options and our Community Financial Aid funding guidelines.

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Medicare and Medicare Supplemental

  • For patients with Medicare coverage, Patient Financial Services will bill Medicare or the Medicare HMO.
  • For each benefit period, Medicare pays for all covered costs except the Medicare Part A deductible (2014 = $1,216) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. For each benefit period the patient pays (calendar 2014):

- Days 1 – 60 = $1,216
- Days 61 – 90 = $304 per day
- Days 91 – 150 = $608 per day (Lifetime Reserve Days) - All costs for each day beyond 150 days 
- Days 151 and beyond = all costs 

Note: There are 60 Lifetime Reserve Days available at day 91

Clinic and Outpatient
The patient/guarantor is required to complete a Medicare Secondary Payer Questionnaire at the time of registration to assist in processing the Medicare claim quickly and efficiently. If the patient has a Medicare supplemental policy, we will bill any portion of the bill that Medicare or Medicare HMO does not pay to the supplemental insurance carrier. If the supplemental insurance does not pay within 45 days, the patient is billed. It is the patient’s responsibility to follow up with the insurance company that failed to make the payment.

  • Medicare patients must advise Patient Financial Services of any additional insurance policies. It’s also important to know if your supplemental policy is a basic supplemental policy, Blue Cross Blue Shield Exact Fill, or a maintenance policy. If there is no secondary insurance, and the total balance due was not collected in advance, we will bill the patient/guarantor.
  • Lymphedema and serial casting supplies are considered to be cash and carry items. Patients will be informed of their responsibility for payment of items prior to registration and during registration.
  • Patient Financial Services may issue an advance beneficiary notice (ABN), as required by Medicare. An ABN is a written notice that a physician or hospital gives to a Medicare beneficiary. The purpose of the ABN is to inform a beneficiary before he or she receives specified items or services that otherwise might be paid for by Medicare that Medicare probably will not pay for them for that particular beneficiary on that particular occasion. The ABN allows the beneficiary to make an informed consumer decision whether or not to receive the items or services for which he or she may have to pay our of pocket or through other insurance.

Part B Outpatient Deductible: $147 per year for calendar 2013 (covers Medicare eligible physician services, outpatient hospital services, certain home health services, and durable medical equipment). Note: Patient pays 20% of the Medicare-approved amount for services after meeting the $147 deductible.

The following services are not covered by Medicare: drivers training, pool therapy, recreational therapy services, and social work charges. Prior to scheduling non-covered services, a Patient Financial Services representative will contact the patient to discuss self-pay options and our Community Financial Aid funding guidelines.

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Workers’ Compensation

Inpatient, Clinic, and Outpatient
If the referring facility determines a patient is admitted as a result of an injury at work, Patient Financial Services must bill the workers’ compensation carrier. Patient Financial Services will submit a bill to either the patient’s employer or the employer’s insurance company, as directed. It is the patient’s responsibility to complete all accident claim forms and appropriate workers’ compensation forms prior to admission or services to ensure prompt payment. In the event workers’ compensation rejects or doesn’t pay any claim under $1,500, the patient will be billed. In the event that the claim is pended by workers’ compensation and is also over $1,500 the patient will not be billed for the balance due; the account will then be turned over to the hospital attorney for further pursuit.

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Blue Cross Blue Shield (BCBS)
Blue Cross Federal
Blue Cross MESSA
Blue Cross Trust
Blue Choice
Blue Cross Out-of-State Plans
Blue Care Network

 

Patient Financial Services will bill all Blue Cross Blue Shield plans. Most Blue Cross plans generally have deductibles and/or co-insurance that are the patient and/or guarantor’s responsibility to pay.

Inpatient
Most Blue Cross policies require pre-certification approval for inpatient admissions.

The following inpatient services are not covered by most Blue Cross Blue Shield plans: drivers training and psychology services that are non-testing. A Patient Financial Services representative will meet with the patient regarding self-pay options and the Community Financial Aid (charity care) funding guidelines.

Clinic
Clinic services are often not a covered benefit. Patients will be asked to make payment prior to receiving clinic services.

Clinic and Outpatient
If the patient has Blue Cross Blue Shield Master Medical coverage, it is the patient’s responsibility to bill Master Medical for services following any denials from regular Blue Cross Blue Shield. It’s important for the patient to submit this claim form to Blue Cross Blue Shield Master Medical immediately and return the payment or responses to our office promptly. Patient Financial Services will allow 90 days for the Blue Cross Blue Shield Master Medical payment of response, at which time the patient will be responsible for the full balance. The secondary insurance carrier cannot be billed until a Blue Cross Blue Shield Master Medical response is received.

Lymphedema and serial casting supplies are considered to be cash-and carry-items. Patients will be informed of their responsibility for payment of items prior to registration and during registration.

The following outpatient services are not covered by most Blue Cross Blue Shield plans: drivers training, social services, recreational therapy and medical supplies. Prior to scheduling non-covered services a Patient Financial Services representative will contact the patient to discuss self pay options and our Community Financial Aid funding guidelines.
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No-Fault Carriers

Inpatient, Clinic, and Outpatient
If the patient is admitted as a result of an auto injury, Patient Financial Services will bill the auto insurance carrier. The patient is responsible for filing an accident claim or the assigned claims forms prior to admission or services. Any services not covered by no-fault will be billed to any secondary insurance. If the patient does not have a secondary insurance, the balance will be billed to the patient. In the event no-fault rejects the claim or does not respond in 90 days, the patient will be billed. It will be up to the patient to seek payment from the auto no-fault carrier.

No-fault payers are responsible for paying the amount due in full within 30 days of the receipt of the bill.
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Other Insurance

Patient Financial Services also bills for all commercial, individual, group, self-insured, HMO, PPO, and Champus policies. It is the patient’s responsibility to check with his or her employer or insurance carrier to obtain and complete the required forms.

For clinic services, it is the patient’s responsibility to obtain prior authorization for all services if it is a requirement of your policy. Any services non-covered services will be billed to the patient.

Insurance payers are responsible for paying the amount due, in full, within 30 days of receipt of the bill.
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Patients are responsible for reporting any insurance changes to Mary Free Bed Rehabilitation Hospital.

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