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Understanding the Billing Process

 

YOU RECEIVE HOSPIAL SERVICES - You are ultimately responsible for your bill

IN 15-30 DAYS

 

 HOSPITAL BILLS INSURANCE

- Star Valley Medical Center bills your insurance company as a courtesy

IN 3 MONTHS MAXIMUM

- We bill up to three insurance plans

YOU ARE BILLED FOR WHAT INSURANCE DOES NOT COVER (1ST STATEMENT)

- We attempt to get payment from insurance for 3 months

- It may take up to 6 months before you receive any bill

HOSPITAL SENDS YOU A STATEMENT EVERY 30 DAYS FOR 3 MONTHS

- At any time, you can talk to us about payment plans

- We offer 3 months interest free

- We have guaranteed loans

 

BILL GOES TO CREDIT BUREAU - Call us anytime with questions at 307-885-5800

Glossary of Billing Terms

Account number (visit number). The unique reference number assigned to each hospital encounter.

Adjustment. A transaction that increases or decreases your accounts receivable balance. A debit increases your balance and a credit decrease your balance.

Assignment of benefits. An agreement in which you instruct your insurance organizations to pay the hospital, physician or medical supplier directly for your medical services. Your insurance organization decides the payment rate and your responsible portion.

Bad debt. Debt that is uncollected after several attempts. Sharp HealthCare uses an agency, Progressive Management Systems, to collect on bad debt accounts.

Balance. Amount outstanding on your account. Your statement will indicate who currently owes the balance.

Capitation. The fee an insurance organization occasionally pays to a health care provider or facility for medical services. Usually providers are paid a per-member, per-month fee to accept these patients or provide this type of service to patients.

Charge itemization. A list of all items, medications, room charges and procedures. This does not necessarily indicate amount owed by you or your insurance.

Claim. A form submitted to the insurance organization for payment of benefits.

Co-insurance. The part (usually a percentage) of the covered health care cost for which you are financially responsible. Often, co-insurance applies after you meet your deductible.

Coordination of benefits. How insurance organizations determine the primary payment source when you are covered under more than one insurance organization or group medical plan. Many insurance contracts state that if you are covered under more than one insurance plan, benefits will be coordinated so that total benefits paid will not be more than 100% of the bill.

Co-payment. The contractual provision that requires you to pay a specific charge for specific service, usually when you receive the service. A co-payment usually applies to office visits, prescriptions, emergency or hospital services.

Covered services. Specific services or supplies for which your insurance reimburses you or pays your health care provider. These consist of a combination of mandatory and optional services and vary by state.

Deductible. The agreed amount you must pay before your insurance organization will pay a claim. Usually, you have 12 months to meet your deductible. Eligible expenses after you meet your deductible are then paid for the rest of that 12-month period.

Disallowed amount. The difference between the charge and the amount your insurance organization approves. If your health care provider is under contract with your insurance organization to accept the approved amount, you aren't billed for the difference. If your provider is not under contract, you may be billed for this difference.

Group number. The number of your insurance organization group. See your insurance card.

Guarantor. The individual responsible for paying this bill. Patient statements are addressed to this person.

Ineligible expense. A charge your insurance organization will not pay because it is not covered by your insurance plan. If your health care provider is under contract with your insurance organization, this charge may be billed to you.

Limit of allowance (contractual allowance). The difference between what your insurance organization approves and your health care provider charges for a procedure. You are not billed for this difference when your health care provider is under contract to accept your insurance organizations' approved amount. This difference shows up on your account as an account adjustment, decreasing the balance.

Non-participating health care provider. A health care provider who is not under contract with an insurance organization to accept patients and receive the insurance organization's approved amount on all claims. You pay the difference between its approved amount for a service and this health care provider's charge.

Participating health care provider. A health care provider who contracts with an insurance organization to accept patients and receive the insurance organization's approved amount on all claims.

Place of service. The facility where service is performed.

Policy number. The number on your insurance policy. See your insurance care.

Policyholder. The name of the person who took out or purchased the insurance policy. This person owns the policy. Also called a subscriber or guarantor.

Pre-authorization (pre-certification). The process of getting permission from your insurance organization for certain services before they are provided so that the services can be considered eligible expenses. Usually required for hospital and outpatient services.

Primary insurance. The insurance organization with first responsibility for paying eligible insurance expenses for your medical service (after you have paid your deductible and co-payments). If you have additional insurance, those organizations would work with your primary insurance organization to cover eligible expenses according to your insurance policies.

Referral. Written authorization from your health care provider to see another health are provider. For example, your primary care provider may provide written authorization for you to see a specialist.

Secondary insurance. The insurance organization with second responsibility for paying eligible insurance expenses for your medical service (after you've paid your deductible and co-payments). This insurance would work with your primary insurance organization to cover eligible expenses according to your insurance policies. This insurance organization is billed second - after your primary insurance organization ahs been billed.

Subscriber. The person who purchased the insurance. Also known as a policyholder or guarantor.

Tertiary insurance. The insurance organization with third responsibility for paying eligible insurance expenses for your medical service (after you've paid your deductible and co-payments). This insurance would work with your primary and secondary insurance organizations to cover eligible expenses according to your insurance policies. This insurance organization is billed third - after your primary and secondary insurance organizations have been billed.

Units. The number of a particular item that were ordered and received.