srmc guide to patient billing pfs guide to...srmc collect co-pays, coinsurance, deductible, or a...
TRANSCRIPT
About SRMC Sidney Regional Medical Center is a critical access hospital
offering a wide array of services including a 25-bed Acute
Care, Critical Care unit, 24-hour provider covered Emergency
Room, Physicians Clinic, Walk-in Clinic, Surgical services,
Home Health and Hospice, Extended Care Unit, Assisted
Living facility and much more. SRMC serves a seven-county
area in the southern Nebraska Panhandle. SRMC and its
partners provide many services not traditionally found in a
rural community.
Mission
To revolutionize healthcare services.
Vision
To be the healthcare center of choice.
Value
Do the right thing. Make a difference.
Our Team
SRMC employees more than 390 people including
approximately 70 volunteers. Our medical staff includes 4
family practice physicians, 2 general surgeons, a urologist,
hospitalists, 10 certified physician assistants and almost 20
visiting providers specializing in areas such as ENT,
cardiology, gastroenterology, orthopedic surgery, pain
management and podiatry.
Sidney Regional Medical Center complies with applicable Federal civil rights laws and does not dis-criminate on the basis of race, color, national origin, age, disability, or sex. This institution is an equal
opportunity employer and provider. 1000 Pole Creek Crossing ∙ Sidney NE 69162 308.254.5825 ∙ www.SidneyRMC.com
Doing the right thing! Making a difference!
Pat ient Financ ia l Serv ices
SRMC Guide to
Patient Billing
Page 2
Note from the CEO
The cost of healthcare is certainly a hot topic.
At SRMC, our mission is to ’revolutionize healthcare
services’ and we take this mission to heart with every
patient we care for.
Our mission supports our team’s vision, ‘to be the
healthcare system of choice.’ With this in mind, we also
have a value statement and that says ‘do the right
thing, make a difference.
All this stated, we understand how complex healthcare
and the billing for services is and how confusing it can
be. This guide is designed to truly promote transparen-
cy and be a helpful tool when planning your next visit or
preparing for a procedure. We hope you will find it use-
ful. As well we also have several tools available online
including the website, www.SidneyRMC.com and our
SidneyRMC app FREE in the App store and Google
Play.
We know you have choices in healthcare we want to
make sure you have everything you need when decid-
ing where to go and how to pay for your healthcare
needs.
Sincerely,
Jason Petik, CEO
NONDISCRIMINATION AND ACCESSIBILITY REQUIREMENTS AND NONDISCRIMINATION
STATEMENT:
ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you. Call 800.752.6096, option 1.
SPANISH ATENCIÓN: si habla Española, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 800.752.6096.800-54 VIETNAMESE CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 800.752.6096.
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CUSHITE-OROMO: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 800.752.6096.
GERMAN ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer:
800.752.6096.
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오.
NEPALI: धधधधध धधधधधधध:ध धधधधधधधधध धधधधधध धधधधधधधधधधध धधध
धधधधधधधधध धधधधधध धधधध धधधधधध धधधधधधध धधधधधधधधधध धधधधध
धधधधधध ध ध धधध धधधधधधधध ध RUSSIAN: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 800.752.6096.
LAOTIAN: धधधधधध: धध धधध ध धध धधधध ध धधधधध धधध, धधधधध धध धधधधध धध
धध धध धधध धधधधधध, धधधधधध धधध धधध ध, धधध धधध धध धधधधध धध धध.
धधध KURDISH قەسە دەکەيت، خزمەتگوزاريەکانی يارمەتی زمان، بەخۆڕايی، بۆ تۆ بەردەستە. پەيوەندی بە کوردی ئاگاداری: ئەگەر بە زمانی بکە 800.752.6096FARSI: . تماس بگيريد 800.752.6096: اگر بە زبان فارسی گفتگو می کنيد، تسهيالت زبانی بصورت رايگان برای شما فراهم می باشد. با توجه JAPANESE: 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。800.752.6096 まで、お電話にてご連絡く
ださい。
Sidney Regional Medical Center (SRMC) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Sidney Regional Medical Center does not exclude people or treat
them differently because of race, color, national origin, age, disability, or sex.
Sidney Regional Medical Center:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
Qualified interpreters
Information written in other languages
If you need these services, contact Language Line at 800.752.6096, option 1, 24 hours a day, daily.
If you believe that Sidney Regional Medical Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Compliance Officer, Sidney Regional Medical Center, 308.254.5825 ext. 1440, fax 308.254.8080. You can file a grievance in person or by mail or fax. If
you need help filing a grievance, the Compliance Officer is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights,
electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
800.368.1019, 800.537.7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/filing-with-ocr/index.html.
800.752.6096.
800.752.6096.
800.752.6096.
800.752.6096.
Page 34
Notes:
Sidney Regional Medical Center Page 3
Table of contents
Introduction 4
Glossary 5-6
Billing process 7-9
Pre-service estimates 10
Payment options 11-13
Guarantor statements 14-16
Guarantor letters 17-18
Charity Care 19-20
Bills will you receive 21
Payment options 22
In-network insurance 23
Coordination of Benefits 24
Office Visit Charges 25
Wellness and annual exams 26
School/athletic physicals 27
Self-administered medication 27
FAQ’s 28-33
About SRMC 33
Sidney Regional Medical Center
Page 4
Introduction
Patient Financial Services—Here to provide patients with
the tools and resources to understand insurance
coverage and manage medical expenses in a caring,
honest and confidential manner because your financial
well-being is important too.
Thank you for choosing SRMC for your health care
needs. Insurance and paying for medical expenses can
be overwhelming and confusing. SRMC is committed to
making this experience a positive one.
In addition to the monthly premiums, most insurance
policies require patients to pay a portion of the medical
expenses in the form of co-pays, coinsurance or
deductibles, or any combination of these.
Insurance companies have set the expectation that
SRMC collect co-pays, coinsurance, deductible, or a
combination of those from patients. To help manage this
expense and eliminate any surprises after services,
SRMC takes a proactive approach in providing an
estimate and payment arrangements prior to or at the
time of service.
Sidney Regional Medical Center
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 33
FAQs (cont.)
account to be referred to an external collection agency. Payment in full or payment plans must be established prior to the time of service on all non-emergent services.
Q. WHAT IS THE PHONE NUMBER OF THE COLLECTION
AGENCY MY ACCOUNT WAS SENT TO?
A. SRMC uses two collection agencies. If the guarantor’s last name begins with A-M, please contact Panhandle Collections at 308-632-5210. If the guarantor’s last name begins with N-Z, please contact Credit Management Services at 308-382-3000.
FAQ Patient Resources
Q. WHY DO YOU NEED TO SEE MY INSURANCE CARDS
EVERY TIME I HAVE AN APPOINTMENT?
A. To ensure your claim is processed as efficiently as possible. When we verify we have the most current card and billing address on file, we can reduce potential delays during the claim process caused by records not matching.
Q. WHAT INFORMATION DO I NEED TO BRING WITH ME TO
THE HOSPITAL?
A. Patients should bring the following information when registering:
Insurance Card/Medicare/Medicaid card Driver’s license Co-pay or deductible Worker’s compensation information (if applicable) Auto coverage and claim information for auto accident (if
applicable)
Q. IF I NEED MEDICAL ATTENTION BUT CAN NOT AFFORD
TO PAY FOR IT, WHAT CAN I DO?
A. No one is turned away from SRMC needing emergent/emergency care because of inability to pay. We direct patients to a Patient Account Specialist the Financial Counselors located in the Patient Financial Department who will work with you to develop a
Page 32 Sidney Regional Medical Center
FAQs (cont.)
Typically, a patient will receive multiple EOB’s for one service as insurance pays the facility charges (supplies, room, medications, labs, radiology tests) separately from the fees charged by the physicians or other providers.
Q. HOW ARE YOUR PRICES DETERMINED?
A. The Nebraska Hospital Association hospital guide is used to compare pricing with other facilities in Nebraska. Prices are also determined by reviewing what insurance companies will allow for services.
Q. HOW ARE CHARGES DETERMINED?
A. Charges are based on the type and level of service received. Physicians document details of the service provided. Charges are based on that documentation.
Q. I CAME IN FOR MY ANNUAL WELLNESS EXAM BUT MY INSURANCE COMPANY IS NOT PAYING FOR IT BECAUSE IT
WAS NOT “CODED” AS A WELLNESS EXAM?
A. At a wellness/annual visit the insurance company pays for the provider to assess the patient’s health and for certain screenings for any undiagnosed issues. If the patient discusses any prior or current ailments, the visit may no longer be considered a physical. It will then be coded and billed as an office visit and any applicable co-pays, deductible or co-insurance will be due from the guarantor. If the patient has other ailments needing to be discussed or the patient becomes ill prior to this physical, a separate visit will be necessary.
Q. WILL SRMC PRE-CERTIFY SERVICES OR DO I?
A. Although there are some services that SRMC will pre-certify, it is best for the guarantor to contact their insurance for pre-certification as well.
Q. HOW DO I AVOID COLLECTION ACTIVITY?
A. Delays in full payment or failure to establish a payment plan that meets minimum guidelines for the amount due may cause this
Page 5
Glossary
The following terms are frequently used when discussing
medical billing, insurance and patient financial
responsibilities for healthcare services.
Co-insurance
The percentage set by your insurance company that
you pay for services after you have paid the total
annual deductible amount.
Co-pay
A co-pay is the amount specified by your insurance
company to be paid for each office visit with a doctor.
Some plans also have co-pays for other services such
as Physical Therapy and ER Visits. Your co-pay
amount may be listed on your insurance card.
Contractual Adjustment
This is the discount that is given on services based on
the contract SRMC has with your insurance company.
Deductible
The annual amount set by your insurance company
that must be paid by you before insurance pays for
services, and before co-insurance applies to your
services.
Explanation of Benefits (EOB)
This is the paperwork you receive from your insurance
company showing what they paid and what they have
determined is your responsibility to pay, per your
coverage. This amount should match the statement
you receive from Sidney Regional Medical Center.
Page 6
Typically, a patient will receive multiple EOB’s for one
service as insurance pays the facility charges
(supplies, room, medications, labs, radiology tests)
separately from the fees charged by the physicians or
other providers.
Out of Pocket (OOP)
This is the most you will pay during a policy period
(typically one year) before your insurance starts to pay
100% for covered services. This amount generally
consists of the full amount you have paid for
deductibles, co-insurance and co-payments. There are
exceptions to what some plans apply to OOP.
Premium
This is the amount you pay your insurance company to
obtain coverage. It is typically paid monthly or per
paycheck. If your employer provides insurance, this
amount often comes directly out of your paycheck. If a
premium is not paid, insurance coverage lapses and is
no longer valid after the grace period.
The billing process begins the day services are
received.
Sidney Regional Medical Center
Glossary (cont.)
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 31
Q. WHAT IS THE MINIMUM PAYMENT I CAN MAKE?
A. The minimum payment will be different for each account and is based upon the total amount of your outstanding balance.
Q. WHY DO I NEED TO ESTABLISH AN OFFICAL PAYMENT
PLAN?
A. By agreeing to an interest free, no fee, no penalty payment plan, we keep your account internally and keep it from aging out to an outside source, who would charge interest. If you are unable to pay your balance, SRMC has payment options available.
Q. DO YOU HAVE FINANCIAL ASSISTANCE?
A. Yes. We do offer charity care for those who qualify. Qualification is based upon federal poverty guidelines, equity and assets of the patient, along with other criteria. Complete an application here.
Q. WHY ARE FAMILY VISITS NOT LISTED ON ONE
STATEMENT UNDER ONE ACCOUNT NUMBER?
A. Statements are generated per guarantor. The guarantor is the person who signed the consent form at the time of admissions, as this person is signing for services and to be responsible for any payment that is due.
Q. HOW CAN I GET ALL FAMILY VISITS ON ONE STATEMENT?
Contact the SRMC Patient Financial Services at 308.254.8778, Monday – Thursday 8am-5pm and Friday, from 8am - 4pm.
Q. HOW DO I RECEIVE AN ITEMIZED STATEMENT?
A. To request an itemized statement, email our team at: [email protected] or call us at 308.254.8778 Monday – Thursday 8am-5pm and Friday, from 8am - 4pm.
Q. WHAT IS AN EOB (Explanation of Benefits)?
A. This is the paperwork you receive from your insurance company showing what they paid and what they have determined is your responsibility to pay, per your coverage. This amount should match the statement you receive from Sidney Regional Medical Center.
FAQs (cont.)
Page 30 Sidney Regional Medical Center
FAQs (cont.)
Q. CAN I GET A DISCOUNT ON MY BILL?
A. Yes, if you do not have insurance or you had a service that your insurance does not cover, you could be eligible for a discount if you pay in full within 45 days from the date of service. The discount will be applied to your account upon receipt of payment in full.
Q. I HAVE INSURANCE WHY DID I RECEIVE A BILL?
A. This is the amount that your insurance company left due to the guarantor. Typically this amount is for co-pays, deductibles, co-insurance or for a service the insurance company does not cover under your policy. You should have received an EOB(s) from your insurance company that matches what SRMC has billed you
Q. WHO SHOULD I CALL IF I BELIEVE THAT THE CHARGES
ON MY BILL ARE INCORRECT?
A. If you have any concerns regarding your bill, please call 308.254.8778 we would be delighted to answer any questions you might have about your bill.
Q. I HAVE MEDICARE AND SUPPLEMENTAL INSURANCE.
WHY DO I OWE A BALANCE?
A. Unfortunately, Medicare does not cover oral or self-administered medications given in an outpatient setting at the hospital. An outpatient setting at Sidney Regional Medical Center would include: 1) a visit in the ER, 2) being admitted for observation or 3) outpatient surgeries.
Q. DO YOU HAVE PAYMENT PLANS AVAILABLE?
A. Yes, we have payment plans available. You may be eligible to establish a monthly payment plan. Please call 308.254.8778 to find out what payment plans are available for your balance due.
Page 7
Billing process
Insured patients
Generally, within 4-6 weeks of the visit, patients should
receive an explanation of benefits (EOB) from the
insurance company. Shortly thereafter, patients will
receive a statement from SRMC. Patients should
compare the EOB to the "Patient Responsibility Due"
portion of the SRMC account statement. The balance
owed according to the EOB and the balance owed
according to the SRMC statement should equal. If they
are different, please contact Patient Financial Services.
In some cases, insurance companies may delay
processing of claims. Patients will receive information
from the insurance company regarding the delay.
Page 8
If insurance doesn’t pay, SRMC will send a statement
showing patient amount due if insurance either doesn’t
pay for the service or leaves a remaining balance due
as patient responsibility.
Non-covered services
Non-covered services means that the patient’s contract
with the insurance company didn’t include coverage for
the services. For questions regarding coverage, contact
the insurance company to discuss coverage limits or to
add services to the contract.
Multiple claims on one visit
For most payers, SRMC is required to bill professional
fees and facility fees separately. A statement from
SRMC is not sent to the patient until insurance pays on
each one, which can cause a delay in patient receiving
the first statement from SRMC.
Facility fees are for the service or procedure being
provided.
Professional fees are for the doctors, physician
assistants and anesthesiologists.
Multiple insurance
coverage
If a patient has more than
one insurance, this may
also cause a delay as all
claims must be processed
Sidney Regional Medical Center
Billing process (cont.)
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 29
FAQs (cont.)
Q. WHAT COULD DELAY MY BILL?
A. Insurance companies requesting additional information from SRMC or from the patient in regards to your services. Please read all communication you get from your insurance company. If you fail to meet their request for information you could get end up paying for services that your insurance company should be paying.
Q. HOW CAN I MAKE A PAYMENT?
A. We accept the following forms of payment: Cash, Check, Credit Card/Debit(MasterCard, Visa, American Express,
Discover), Money Orders and cashier checks and have the following payment options:
Pay Online: www.SidneyRMC.com
select “Pay Online” Pay by phone: Call us at 308.254.8778 Mail your payment to: SRMC Attn: PFS Dept 1000 Pole Creek Crossing Sidney, NE 69162-1714 Stop by Patient Financial Services: 1000 Pole Creek Crossing Sidney, NE 69162
Monday - Thursday 8am - 5pm
Friday 8am - 4pm
Page 28
FAQs
Sidney Regional Medical Center
Q. WHEN WILL I RECEIVE MY BILL?
A. If you have insurance, and you provided our office with a current insurance card, our first step is to bill your insurance company. After the insurance company has processed claim(s), you will receive a bill with any unpaid portion that is due. This process usually takes an average of 30-60 days. If you have a secondary insurance or have multiple claims on one account this process can take longer. If you do not have insurance, you will receive a bill on the first date we send out statements, following your visit. Statements are sent out every 28 days.
Q. HOW MANY BILLS WILL I RECEIVE?
A. For most visits you will receive one bill from SRMC for
services received at our facility. An additional bill may be
received for the following:
Some visiting physicians bill their own professional fees,
these bills will come from the specific office of that provider.
Radiology services - an additional bill will be sent from
Advanced Medical Imaging Consultants (AMIC) for the
radiologist reading fee.
Cardiac event monitors (14 to 30 day monitors) – a bill from
Life Watch for the rental fee of the monitor.
Patients may receive a bill from University of Nebraska
Medical Center, Healthtronics, Prometheus or Liposcience
for some lab work.
Sleep Studies - an additional bill will be sent from Dr. Imes
office, the polysomnographer doctor, for interpretation/
reading of your study.
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 9
Pre-service estimates
Billing process (cont.)
by both the primary payer and the secondary payer
prior to a statement being sent
Liability claims in litigation
SRMC will file liability claims or accident and injury
claims with the liable party and or with the patient’s
insurance. If these claims are not paid by the billed
parties and end up in litigation between parties, these
claims will become the patient’s responsibility,
otherwise known as “private pay.”
Private pay patients
Patients that are not covered by insurance are known
as “true private pay” patients. Statements for services
at SRMC will be received approximately 30 – 45 days
from the date of service. Balances paid in full within 45
days of date of service, may be eligible for a “true
private pay” discount.
SRMC provides estimates either prior to scheduled
hospital services or at the time of service for clinic and
unscheduled visits at admissions. At this time payment
options are discussed and payment arrangements are
made.
SRMC utilizes software which produces cost estimates
based on customary/standard charges. It retrieves
patient-specific insurance information from the patient’s
insurance plan to provide an estimate of both the total
cost of services and what insurance expects the patient
to pay for hospital services.
Page 10 Sidney Regional Medical Center
Pre-service estimates (cont.)
Deductible and co-insurance on clinic visits is based on
the cost of an average level office visit. The office visit
level may change depending on how it is documented.
Please refer to page 25. Any unknown lab work or
other procedure that may occur during your visit will be
billed to the patient after insurance has been billed.
This estimate is for routine and usual charges for the
services, exams or procedures requested. The
information provided is a best estimate based on
the information selected and is not a guarantee of
what you will be charged. Please understand that in
many cases it is impossible to predict the final charges
as there are many variables involved in actual services
such as: the length of time spent in surgery or recovery,
specific equipment, supplies, and medications required,
additional tests required by your physician, and/or any
unusual special care or unexpected conditions or
complications.
If you have insurance, your benefits will ultimately
determine the amount you owe. Not all services are
covered by all insurance policies. To check your
coverage, contact your insurance.
Some insurances will cover an annual wellness visit at no
cost to the patient. If the child has not had an annual exam
within the last 365 days, this service can be provided as their
annual wellness visits as it meets and exceeds the
requirements of a school physical. This will ensure the child
receives the best care at the lowest cost to the guarantor.
Check with the insurance company to verify the plan has
wellness coverage before scheduling a visit, as coverage
varies by policy.
Page 27
School and athletic physicals
Medicare publishes a list of drugs they considered to be “self
-administered drugs”. This does not mean that you actually
took the medication on your own while you were in the
hospital but it is a medication that Medicare considers the
patient could take on their own outside of a hospital setting.
If a patient receives self-administered drugs not covered by
Medicare Part B, the hospital will bill the patient. These
drugs may be covered for anyone enrolled in a Medicare
drug plan (Part D). The patient is then responsible to pay for
the drug and/or submit a claim to Medicare for a refund.
Most hospital
pharmacies don’t
participate in Part D.
If a bill is received,
follow the directions in
the Medicare drug
plan’s enrollment
materials on submitting
an out-of-network claim.
Self-administered medications
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Sidney Regional Medical Center
Please be advised that preventative visits are limited
according to insurance company guidelines. Problem based
issues cannot be discussed at a wellness/annual visit.
At a wellness/annual visit the insurance company pays for
the provider to assess the patient’s health and for certain
screenings for any undiagnosed issues. If the patient
discusses any prior or current ailments, the visit may no
longer be considered a wellness/annual. It will then be
coded and billed as an office visit and any applicable co-
pays, deductible or co-insurance will be due from the
patient. If the patient has other ailments needing to be
discussed or the patient becomes ill prior to this wellness/
annual, a separate visit will be required.
SRMC providers are more than happy to review patient
issues, but a separate visit must be billed according to
standard wellness billing guidelines.
It is important to review the individual policy regarding the
insurance company’s preventative schedule as these vary
by insurance. For questions concerning insurance coverage
contact the company’s human resources department or
insurance supplier for more information.
Wellness and annual exams
Page 26 Sidney Regional Medical Center Page 11
The price of healthcare continues to be costly. In addition
to the monthly premiums, most insurance policies require
patients to pay a portion of the medical expenses in the
form of co-pays, coinsurance or deductibles, or any
combination of these.
Complete understanding of your insurance coverage is
essential when preparing for your next procedure or visit.
This allows you to effectively manage the financial aspect
of your care. We encourage you to establish your payment
arrangements prior to your visit. We understand
emergencies happen and we will work with you to create a
plan that works best. Our team will process your account
with insurance as timely as possibly, in the instance your
insurance does not pay SRMC timely, you may become
responsible for the bill.
Contact Patient Financial Services at 308.254.8778 with questions.
1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Payments options
We would like to allow you as much time as possible to pay
your bill. The sooner you establish a payment option with
SRMC, the smaller your payments will be as they can be
spread out over a a longer period of time.
Payment in full—for your convenience we accept cash, check, money order, and all major credit cards.
Auto-pay/Recurring interest Free payments: Up to 8 months interest-free Auto pay from banking, Flex or credit card Weekly, bi-monthly payments options available Minimum monthly payment amount is $25, on accounts
under $200.
SRMC Care Solution - A convenient extended payment
option.
Auto Pay from Banking, Flex or Credit Card Electronic Statements 4.58% Interest Interest free if paid off within 6 months Up to 60 Months
Page 12
Payments options (con’t)
Sidney Regional Medical Center
Payment option established: Monthly
payments
At the time of service 8
Within 30 days of service date 7
Within 60 days of service date 6
Upon receipt of (after insurance processes):
1st statement 5
2nd statement 4
3rd statement 3
1st collection letter 2
2nd collection letter 1
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 25
Office visit charges
Office
Visit
Level
Description of what estimates are based on
99212 · Minimal - Straight forward medical decision making
· Self limited or minor problems requiring counseling
99213
· Simple – One problem visit. Low complexity of medical
decision making
· Low to moderate problems requiring counseling or
coordination of care
99214
· Moderate - may be one problem or multiple, may also be a
new problem as well as workup (labs, x-rays ordered
prescription ordered).
· Moderate complexity of medical decision making.
· Moderate to High problems requiring counseling or
coordination of care
99215
· High - very detailed exam with multiple problems and/or
workup.
· Greater than 30 minutes spent with provider medical
decision making of moderate complexity.
· Moderate to High problems requiring counseling or
coordination of care
· Complex medical problem(s) requiring comprehensive
evaluation.
These office visits are based on being an established patient
or a patient not being seen for the first time by a doctor.
Prices are for the cost of the office visit only. This does not
include any additional procedure, lab work or radiology that
may occur.
Page 24
Coordination of Benefits
Coordination of Benefits allows plans that provide health or
prescription coverage for a person with Medicare to
determine payment responsibilities.
Are there dependents on the insurance plan?
Does the patient have multiple insurance coverages?
Is the patient a dependent on a spouse’s plan and has
their own coverage?
Are children covered by two or more plans?
If so, we need your help to ensure your insurance company
pays for your services.
In order to ensure payment by the insurance company and
to prevent claim denials made in error, it’s important the
guarantor and/or patient contact the insurance company to
update the Coordination of Benefits (COB). This update is
typically required by the insurer on an annual basis. This is
also important if there have been any significant changes to
the guarantor’s and/or patient’s family (marriage, divorce,
new child, addition of step-children, etc.).
Refer to the back of the insurance card to find contact
information for customer service and contact them to
coordinate benefits.
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Sidney Regional Medical Center
External Loan Option – Contact us to apply:
Charity Care. We understand that medical expense are often
unexpected. Charity Care is available for patients who meet
eligibility criteria. Charity Care is secondary to all other financial
resources available to the patient. Contact a Patient Account
Specialist for more details at 308-254-8778 or to request a copy
of the application.
How to Apply - Apply by completing an application over the
phone, in person, online or via a mailed application.
Online: SidneyRMC.com/Charity Care Program Phone: 308-254-8778 In person at:
Sidney Regional Medical Center 1000 Pole Creek Crossing Sidney NE 69162
Page 13
Payments options (cont.)
American Bank Points West Bank
Minimum Balance $500
7.5% to 10% interest
$50 Origination Fee
Credit Report (optional at bank discretion)
Minimum of 6 months of Employment
Proof of Gross Income (Pay stubs, W-2’s,
Tax Returns)
No previous charge offs or delinquency
with AB
For Balances $750 to 15000
7.5% Interest
$35 Origination Fee
Min Payment amount $100
Credit Report Required
Pay Online: www.SidneyRMC.com select “Pay Online” Pay by phone: Call us at 308.254.8778 Mail your payment to: SRMC Attn: PFS Dept 1000 Pole Creek Crossing Sidney, NE 69162-1714 Stop by Patient Financial Services: 1000 Pole Creek Crossing Sidney, NE 69162 Monday - Thursday 8am - 5pm Friday 8am - 4pm
Page 14 Sidney Regional Medical Center
Patient statements are referred to as guarantor statements.
A person is considered their own guarantor at the age of 19
in the state of Nebraska. If the patient is still on a parent’s/
caregiver’s insurance, that patient will receive a separate
statement due to being considered an adult in the state of
Nebraska.
If the patient is a minor, whoever signs consent for treatment
is the guarantor for that visit. In instances where a minor is
brought in separate times by a different parent, the parent
that signed consent will receive a statement for that visit.
Each time a patient or family member on the same
insurance contract comes in, a new visit will be created.
Each visit with any patient amount due will be on the
guarantor statement.
The profile number, located on the top right of the guarantor
statement, corresponds to the guarantor’s profile. Minors
and adults each have a profile number assigned to the
individual.
When calling to make a payment, please provide the
account number. See following page for location on
statement.
Guarantor statements
Page 23
In-network refers to providers or healthcare facilities
that are part of a health plan’s network. This means the
provider/healthcare facility has a contract with that
insurance company and have negotiated rates for
services and providers.
If SRMC is not in network with the patient’s health
plan, the patient may receive a bill for the services
received. It is always best to call the insurance prior to
receiving services to verify if SRMC and the provider
are in network. Below is a list of in-network insurance
companies with SRMC:
Aetna
Blue Cross and Blue Shield
Cigna (processing through Midlands)
First Health (processing through Coventry Health of Nebraska)
Coventry
Medicare
Medicaid - Total Care Medicaid
Medicaid - UHC Community Plan
Medicaid - Wellcare
Midlands Choice
Multi-Plan (Please contact your insurance company to verify your policy processes all service through Multi-plan)
United Healthcare
In-network insurance
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 22
Multiple payment options are available for your convenience.
Please include account number with payment. If paying via mail or in
person, please include the lower portion of the statement. For questions
regarding
how to pay
contact a
Patient
Account
Specialist.
Convenient payment options
Sidney Regional Medical Center
Pay Online:
www.SidneyRMC.com
select “Pay Online”
Pay by phone:
Call us at 308.254.8778
Mail your payment to:
SRMC Attn: PFS Dept
1000 Pole Creek Crossing
Sidney, NE 69162-1714
Stop by Patient Financial Services:
1000 Pole Creek Crossing
Sidney, NE 69162
Monday - Thursday 8am - 5pm
Friday 8am - 4pm
Page 15
Guarantor statements (cont.)
Page 16 Sidney Regional Medical Center
Guarantor statements (cont.)
The guarantor statements have six columns (see sample
statement on page 14):
Date - the date the service was provided.
Patient admission/description - visit number and brief
description of the type of visit. If there is lab or radiology
done the same day you have a consult/visit with your
doctor, the description will remain consult.
Total charges - amount of total charges for that date of
service. For insured patients, this is the amount SRMC
bills to your insurance.
Patient payments - amount the patient has paid prior to
the statement date.
Insurance payments - amount the insurance has paid
and the amount discounted prior to the statement date.
Patient pay - balance due from the patient.
Patients should look over the EOB from insurance and the
guarantor statement from the servicing hospital to ensure
accuracy. If the EOB does not match the guarantor
statement, contact a Patient Account Specialist.
To set up payment arrangements, make a payment or
request an itemization of a visit, contact a Patient Account
Specialist.
Page 21
Questions need to be directed to the phone numbers
listed on statements.
Radiology Services
Advanced Medical Imaging (AMI) will send a separate
bill for interpretation/reading of your study.
Sleep Studies
Dr. Imes office, the polysomnographer doctor, for
interpretation/reading of your study.
Cardiac Event Monitor
Life Watch for the Rental Fee of the monitor.
Laboratory
Patients may receive a bill from University of Nebraska
Medical Center, Healthtronics, Prometheus or
Liposcience for some lab work.
Visiting Physicians
Specializing in Cardiology, neurology, pulmonology,
ophthalmology, audiology, ear nose & throat physicians
bill professional services directly from their office. A bill
from SRMC for the facility fees for services received by a
visiting physician will also be sent to the guarantor.
If a specialty provider choses to use an external service
(i.e. pathology on biopsies sent to a different lab), the
guarantor may receive a bill from the external service.
Additional billing statements
necessary care.
How to Apply - Apply by completing an application over the
phone, in person, online or via a mailed application.
Online: SidneyRMC.com/Charity Care Program Phone: 308-254-8778 In person at:
Sidney Regional Medical Center 1000 Pole Creek Crossing Sidney NE 69162
Applications are physically available at the SRMC’s
Admission and Patient Financial Services departments and
can be requested via mail by sending a written request to
the above address. The Patient Financial Services
department can provide assistance with the application
processes by being contacted at the above physical address
or phone number.
If there is knowledge, evidence or questionable information
within the application process, supporting documentation will
be required before eligibility is determined. Supporting
documentation may be requested on charity greater than
$5000. Supporting documentation include current year W-
2’s, tax return, vehicle registration, property tax evaluations,
bank statements, unemployment statement and may include
a Medicaid denial letter.
SRMC is not required to have this application available in
additional languages due to the demographics of our
population. However, if you need help we do have a
language translation line available to help us in assisting
you.
REFERENCES Collaboration with the Finance Committee of the Board of Directors, 2009 IRS Code Section 501; Medicare Fairbilling & Collections Act
Sidney Regional Medical Center Page 20
Charity Care (cont.)
Page 17
Guarantor letters will be sent to the guarantor when visits
are scheduled for collections. If the visit is for a minor, the
letter will be sent to the guarantor who signed consent. If
payment arrangements were set up, but are not being met,
the visit will age resulting in a letter being sent.
If multiple visits have aged and are scheduled for
collections, the guarantor will receive one letter per each
visit.
The letter will only contain the patient’s name, patient
number (visit number), the balance on the visit, the day the
patient was discharged, and the patient type. Patient types
are:
Inpatient Outpatient Emergency room Clinic Extended care or long term care
To receive an itemized statement charges please contact
a Patient Account Specialists.
If payments have been made or to avoid being sent to
collections, please contact a Patient Account Specialists at
Guarantor letters
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 18 Sidney Regional Medical Center
Guarantor letters (cont.)
Contact Patient Financial Services at 308.254.8778 with questions. 1000 Pole Creek Crossing ∙ Sidney NE 69162 ∙ 308.254.5825 ∙ www.SidneyRMC.com
Page 19
Overview
SRMC is committed to the provision of healthcare services
to all persons in need of medical attention regardless of
ability to pay. It is the policy of SRMC to treat all patients/
guarantors equally, fairly and consistently. Patients seeking
financial assistance can apply for charity care. You may be
eligible if you are not insured, underinsured, or not eligible
for sufficient coverage under any government program.
Charity Care is generally secondary to all other financial
resources available to the patient.
Eligible Services
Patients may be considered for charity care for medically
necessary service, on accounts with the current patient due
balances and accounts with service dates within 6 months
following the application approval date. When in question,
Medically necessary services shall be determined by the
examining physician.
Eligibility Requirements
Patients must be residents of Cheyenne or Deuel County
and/or a 20-mile radius of Sidney. Charity will be based on
household income and size, real estate, personal property
and investment equity, with credit to be given for already
existing medical loans, in comparison to the current year
Federal Poverty Guidelines. The HHS poverty guidelines are
published each year in the Federal Register. Free care will
be given to household that is at 100% of the poverty level.
Discounted care will be given at up to 300% of the poverty
level. Those that are eligible shall not be charged more than
the amount generally billed for emergency and medically
Charity Care