Patient Financial Services will bill Medicare or the Medicare HMO if you have Medicare coverage.
For each benefit period, Medicare pays for all covered costs except the Medicare Part A deductible (2015 = $1,260) 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, you’ll pay (for calendar year 2015):
• Days 1-60 = $1,216
• Days 61-90 = $315 per day
• Days 91-150 = $630 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
To ensure fast and efficient processing of your Medicare claim, we require you to complete a Medicare Secondary Payer Questionnaire when you register. If you have a Medicare supplemental policy, we’ll bill any portion of the bill that Medicare or Medicare HMO don’t pay to the supplemental insurance carrier. You’ll then be billed if the supplemental insurance doesn’t pay within 45 days. It’s your responsibility to follow up with the insurance company that failed to make the payment.
• You must alert us to any additional insurance policies if you’re also covered by Medicare. 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. You will be billed if there’s no secondary insurance, and the total balance due was not collected in advance.
• Special circumstances apply for lymphedema and serial casting supplies; you’ll be informed of your 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 you as a Medicare beneficiary. The purpose of the ABN is to alert you to circumstances in which Medicare is unlikely to pay for a specific service or item that is normally covered by Medicare. This allows you to make an informed decision about receiving items or services that you’ll have to pay for out of pocket or though other insurance.
Part B Outpatient Deductible: $147 per year for calendar 2015 (covers Medicare eligible physician services, outpatient hospital services, certain home health services and durable medical equipment). Note: You must pay 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. One of our Patient Financial Services representatives will contact you prior to scheduling any non-covered services to discuss self-pay options and our Community Financial Aid funding guidelines.