Accepted Insurance

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

We can bill all Blue Cross Blue Shield plans. Most Blue Cross plans generally have deductibles and/or co-insurance; you (or a guarantor) will be responsible for these costs.

Inpatient
Most Blue Cross policies require you to have pre-certification approval for inpatient admissions.
Most Blue Cross Blue Shield plans will not cover drivers training and psychology services that are non-testing. One of our Patient Financial Services representatives can meet with you to discuss self-pay options and the Community Financial Aid (charity care) funding guidelines.

Clinic
Clinic services are often not a covered benefit. You may be required to make payment prior to receiving clinic services.

Clinic and Outpatient
If you have Blue Cross Blue Shield Master Medical coverage, it will be your responsibility to bill Master Medical for the services you receive in the event of a denial from regular Blue Cross Blue Shield. It’s important for you 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 allows 90 days for the Blue Cross Blue Shield Master Medical payment of response. Once that time has passed, you 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.

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.

The following outpatient services are not covered by most Blue Cross Blue Shield plans: drivers’ training, social services, recreational therapy and medical supplies. A Patient Financial Services representative will contact you prior to scheduling non-covered services to discuss self-pay options and our Community Financial Aid funding guidelines.

Inpatient
Patient Financial Services will bill the appropriate plan if you have active Medicaid, Medicaid HMO, or Children’s Specialty Health Care Services (CSHCS) coverage. It’s your responsibility to provide us with the most current Medicaid, Medicaid HMO or CSHCS information; please do so prior to receiving services. It’s especially important to ensure we have your most up-to-date insurance information; if you have other insurance, Medicaid will not pay until the other insurance has paid or denied services.

An admission will not occur until the pre-authorization is received in the case of Medicaid HMOs requiring preauthorization of an inpatient admission.

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.

Inpatient, Clinic and Outpatient
We will bill the appropriate auto insurance carrier if you’re admitted because of a car accident or other automobile-related injury. You are responsible for filing an accident claim or the assigned claim forms prior to admission or services. Any services not covered by no-fault will be billed to any secondary insurance. The balance will be billed to you if you don’t have a secondary insurance carrier. You’ll also be billed in the event no-fault rejects the claim or does not respond in 90 days. In such cases, it is your responsibility 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.

Patient Financial Services bills for all commercial, individual, group, self-insured, HMO, PPO and CHAMPUS policies.

It’s your responsibility to:

• Check with your employer or insurance carrier to obtain and complete the required forms
• Obtain prior authorization for all clinic services if it’s a requirement of your policy. Any non-covered services are billed to you

Insurance payers are responsible for paying the amount due, in full, within 30 days of receipt of the bill.

Our experts in patient financial services will review your options with you if you aren’t insured and you don’t qualify for Community Financial Aid (charity care).

Sums paid for deductibles, co-payments or other out-of-pocket expenses generally don’t qualify for the discount. In cases of financial hardship, a discount for these expenses may be considered and approved by a Patient Financial Services manager. Exceptions are considered on a case-by-case basis.

Inpatient, Clinic and Outpatient
If a referring facility determines you’ve been admitted as the result of an injury at work, our Patient Financial Services must bill your employer’s workers’ compensation carrier. Patient Financial Services will submit a bill to either your employer or your employer’s insurance company.

It’s your responsibility to complete all accident claim forms and appropriate workers’ compensation forms prior to admission or receipt of services to ensure prompt payment. You’ll be billed directly in the event workers’ compensation rejects or doesn’t pay any claim under $1,500. You will not be billed in the event that your claim is pended by workers’ compensation and is larger than $1,500. Instead, these accounts are turned over to our hospital attorney for further pursuit.