Information About Your Hospital Bill
St. Joseph's Hospital Health Center accepts all patients for service without regard to race, color, creed or the ability to pay. Charity care is available to all those who cannot afford to pay. All hospital medical services are covered by this policy. At the hospital's discretion, every type of service and each occasion of service may be treated differently when determining charity care, and charity care may not be available for certain elective admissions or services. As part of the written application process, a patient will be directed to complete a Medicaid application as part of the charity care process. Refusal to complete a Medicaid application or to supply the hospital with the financial information requested, which is necessary to determine financial aid, will result in an automatic denial. The charity care application will be reviewed based on the income claimed on a valid Medicaid application and will require proof of income verification. Charity care is based on gross family income, assets and family size.
As a not-for-profit institution, we depend entirely on income from patient services to maintain our financial stability. Please make sure all arrangements for payment of your hospital bill are made prior to discharge. Our patient account representatives will help you to make payment arrangements, explain hospital billing policies and answer any questions you may have regarding your insurance coverage. A patient account representative may be reached by calling 315-448-5375 (or ext. 8-5375 in house), Monday through Friday, from 8 a.m. to 4:30 p.m.
Managed Care Contracting
In an attempt to respond to requests from employers and individuals to reduce insurance premiums, the insurance industry is becoming more involved in the management of patient care. As a result, our hospital has contracts with numerous insurance companies and managed care companies. These contracts usually require pre-authorization and pre-certification and also give the insurance company the right to determine what is medically necessary for payment purposes.
It is the insurance company's responsibility to inform its insured members of any special terms under its health insurance policy. We do our best to alert our patients of any circumstances that could affect their health benefits, but we cannot assume total responsibility. It is possible that you, the patient, may be responsible for a portion of your hospital bill simply because the requirements of your insurance policy are not met. These amounts can be substantial. Please contact your insurance company if you have any questions with respect to this matter or contact one of our patient account representatives. They can help determine what your insurance will cover and if you are eligible for financial assistance while you recover. A patient account representative may be reached by calling 315-448-5375 (or ext. 8-5375 in house). Don't wait until you are notified that your insurance won't pay before you address this issue.
Once you no longer need acute hospital care, your health insurance may limit what it will pay for. Some insurance carriers will not cover your entire hospitalization, which may be before you are fully recovered. In that case, you will be responsible for payment of continued hospitalization and/or for nursing home placement. You may also be responsible for home care services that your insurance carrier does not cover.
Some employers offer a choice of physician and hospital providers. If you are satisfied with your care at St. Joseph's Hospital and would like to ensure that you may return here for care, if needed, you should tell your employer that you would like St. Joseph's Hospital to be included in its insurance offering.
For more information, go to Managed Care.
How Your Hospital Bill Is Determined
St. Joseph's Hospital has negotiated payment rates with such payers as Blue Cross, commercial insurers and health maintenance organizations. Therefore, the hospital's billing for inpatient services under these negotiated contracts may be based on a variety of payment mechanisms, including co-payments, per diem, fee-for-service and global fees. In addition, the hospital continues to bill Medicare, Medicaid and Workers' Compensation for inpatient services based on diagnostic related groups (DRGs). Medicaid determines the DRG amounts for itself and Workers' Compensation. Medicare determines its own DRG amounts.
What this means to you is that there may not be a correlation between your hospital bill based upon our charges and what the hospital will receive under the DRG system or negotiated contracts. Exceptions to this rule are self-pay patients or patients who are covered by an insurance plan that has failed to negotiate a contract with the hospital. These patients will be billed for their charges.
If your insurance coverage includes deductibles and co-insurance, these amounts will be calculated in accordance with federal or state law or as specified by contract. Any deductible and co-insurance must be paid by you. Please plan to pay the amount of your co-payment when you register for service/admission.
The billing system for hospitals is quite complex and can be confusing. Our patient account representatives will do their best to answer any specific questions you may have. A patient account representative may be reached by calling 315-448-5375 (or ext. 8-5375 in house).
Before being admitted to the hospital, you should understand the terms and conditions of your private insurance coverage, including whether or not any physician who will care for you at St. Joseph's participates in your plan. You should discuss this matter with your physician before your hospitalization. Most physicians (including emergency department physicians, anesthesiologists, radiologists, pathologists and surgeons) involved in your care while in the hospital will bill you separately for their services. Therefore, it is important for you to know if these physicians participate in your private insurance plan. If they do not, you may be personally liable for a portion of their bills.
What If I Feel I Was Billed Incorrectly or Have Questions?
If you believe that your hospital bill is incorrect, please contact the hospital's Business Office immediately at 315-448-5375 (or ext. 8-5375 in house). A patient account representative will attempt to answer any questions and/or resolve billing problems. We make every attempt to ensure each bill is correct.
Other Services For Which You Are Responsible
Listed here are items available at St. Joseph's Hospital Health Center that are not covered by Medicare and most other insurance carriers and which will be your personal financial responsibility if not covered:
- Care not at an acute or skilled level of nursing as defined by Medicare guidelines
- Cosmetic surgery
- Dental services
- Dietetic consultations (if on an outpatient basis)
- The difference between a semi-private and private room rate
- Medical transportation of any kind, including to and from radiation therapy centers
- Most services provided as part of a routine checkup
- Outpatient prescription drugs unless the drug is such that it must be injected by someone other than you
- Pap smears that are part of a routine checkup (generally, those performed more frequently than one every three years)
- Private duty nurses
- TV rental/telephone services or other personal convenience items