Why Doesn't My Insurance Pay For This?
Every policy is different and many have limits on what they will cover.
You may be required to pay more for a service if you have not yet met
your annual deductible, or if the service is not covered by your policy
at 100%. Medicare and Medicaid also have limits on what they will pay
for hospital and physician services.
What is a Co-Pay?
Most HMOs (Health Maintenance Organizations) and some other forms of insurance
require patients to pay a small payment each time they visit a doctor
or go to the hospital. This payment can be as little as $15 or may be
as high as $50 or more, depending on your specific policy. This co-pay
is required each time you visit the doctor or hospital.
What is a Deductible?
Some insurance policies, especially PPO's (Preferred Provider Organizations)
and so-called "traditional" policies, require you and/or your family to
pay a minimum amount per year toward your healthcare expenses. This deductible
could be as little as $250 per year, or as much as $1,000 or more. You
will be required to pay for all of your healthcare expenses until you
have met this deductible amount. After you reach the deductible, your
insurance company will then pay for most, or sometimes all, of your bill.
You only have to meet your deductible once each year.
Be aware that your policy may require both a co-payment and a deductible.
In this case, you will be required to continue to pay a co-pay amount
even after you have met your deductible.
What is Co-Insurance?
In some instances, an insurance plan may require you to meet your annual
deductible as well as to pay Co-insurance even after the deductible is
met. Co-insurance is usually based on a percentage of either the provider's
actual charge or provider's allowed charges. Some insurance plans have
a co-insurance that is as little as 10%, while others can be 50% or more.
What Things Are Covered By Insurance?
Typically, most insurance policies will cover hospital and physician charges
when you are sick, including lab tests, x-rays and other related tests.
Many policies do not cover other services such as medicines, home health,
nursing home stays, wheelchairs, non-emergent ER visits, etc. Please check
your policy for details or call your insurance company if you have questions.
Will I receive a bill from only the hospital?
No. The hospital will bill you or your insurance for only the technical,
or hospital, component of your visit. All physicians (including your ER
Physician, Radiologist, Pathologist, Cardiologist, Anesthesiologist, Neurologist,
etc ) will bill separately for their professional services. If insurance
information is provided at time of service, the companies listed above
will bill your insurance on your behalf.
What Things Will I Be Responsible For Paying?
You will be responsible for paying any amount not covered by your insurance
policy. This may include a co-payment, some or all of your deductible,
co-insurance, and expenses that are not medically necessary or not covered
by your insurance policy.
What if I Have No Insurance Coverage?
Please notify our Financial Representatives and we will work with you
to develop a reasonable payment plan. In some cases, you may be eligible
for charity care coverage.
What is an Insurance Discount Card?
There are companies now selling "discount cards" for hospital and doctor
services to patients. These cards often cost as much as $60 per month
or more ($720 per year) and promise to provide patients with discounts
on their doctor and hospital bills. Unfortunately, many of those discounts
are not offered by your local doctor or hospital; often, they are discounts
provided by large hospitals or physician groups in other cities, or by
chains of health-related businesses (such as pharmacies, etc.). Before
you decide to purchase a healthcare discount card, it is best to determine
if it offers any benefit to you here in our area. Be sure to ask if your
doctor or hospital will honor the card and offer you a discount.
What if I Can't Afford To Pay All of My Bill Right Now?
If you are unable to pay your bill in full upon receipt, you must notify
St. Joseph Medical Center's Business Office so that a reasonable payment
plan may be worked out. Most balances must be satisfied within six months
of the date or service, or date that insurance paid.
Who Can Receive Charity Care?
Most patients are eligible for charity care at St. Joseph Medical Center
if their income falls below 200 percent of the federal poverty level,
based on the size of their family. Your financial counselor can help determine
if you are eligible for charity care at St. Joseph Medical Center.
Will I Get Calls From Bill Collectors?
If you pay your bill on time and according to the payment plan you work
out with St. Joseph Medical Center, your account will not be referred
to a Collection Agency. It is very important that you contact the Business
Office immediately if you are unable to pay any portion of your bill.
In most cases, St. Joseph will work with you to pay what you owe. However,
you must be on a formal contract agreement in order to avoid further collection
from a collection agency.
How Do I Reach Customer Service?
Customer Service Representatives are available to answer your questions,
Monday through Friday, 7 a.m. - 6 p.m.
St. Joseph Medical Center Business Office