Hospital Bills and Insurance
All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the health system’s billing procedures and charges. If there is a question about your insurance coverage, a member of the Insurance Verification Department will contact you or a member of your family while you are here. Information is needed in order to process your claims.
If You Have Health Insurance
We will need a copy of your identification card. We also may need the insurance forms, which are supplied by your employer or the insurance company. You will be asked to assign benefits from the insurance company directly to the health system.
If You Are a HMO or PPO Member
Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your healthcare plan and their services may not be covered.
If You Are Covered by Your Auto Insurance
Regardless of whose fault the nature of your visit is, Capital Health will need a copy of your automobile insurance card, or the card of the driver of the car you were in when you were in the accident. This should be supplied immediately to prevent you from getting any payment notices or having your account sent to a collection agency.
If You Are Covered by Medicare
We will need a copy of your Medicare card to verify eligibility and process your Medicare claim. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others. Deductibles and co-payments also are the responsibility of the patient.
If you receive Medicare, you should have been given Medicare information on admission called "An Important Message from Medicare." This briefly describes some of your rights as a Medicare patient. We are proud to be a participating Medicare provider.
If You Are Covered by Medicaid
We will need a copy of your Medicaid card. Medicaid also has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary.
If You Have No Insurance
A representative from the Insurance Verification Department will discuss financial arrangements with you. A health system representative who is a representative of the Division of Family Services is also available to assist you in applying for Medicaid or other government assistance programs. Please call the Patient Accounting Department at ext. 6023 or dial directly at 609-394-6023 if you have been discharged and not made any arrangements to resolve your account.
If You Come Into the Emergency Room Without Your Insurance Information
Please contact the Patient Accounting Department at ext. 6023 or dial directly at 609-394-6023 to supply them with your insurance information. This will prevent you from getting any bills for services.
Your Bill for Hospitalization
As a service to you, the health system will submit bills to your insurance company and will do everything possible to expedite your claim. But you should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospitalization bill. We have several payment options available to assist you in paying your bill.
Your bill reflects all of the services you receive during your stay. Charges fall into two categories – a basic daily rate, which includes your room, meals, nursing care, housekeeping, and charges for special services which include items your physician orders for you, such as x-rays or laboratory tests.
If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists, and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.
For More Information
If, at any time before or during your hospitalization, you should receive a letter from your insurance company, or Capital Health’ Utilization Review, and you have questions or disagree with any decisions made, a representative from the Department of Quality & Resource Management will be happy to answer your questions or assist you in appealing those decisions. Please contact us at ext. 6080 (Capital Health Regional Medical Center) or ext. 4286 (Hopewell).
If you have any questions regarding your hospitalization bill, please call ext. 6023 or dial directly at 609-394-6023.