Many steps are involved with registration and health care billing. These are the typical steps between the time you receive non-emergent medical services and you receive your bill:
- When you go to your hospital or health care provider's office for care, the admitting or office registration department* gathers information about you and/or the person responsible for paying for the services (the guarantor) and the insurance organization that will be billed. You will be asked to provide: insurance card, photo identification, and a prescription or order. Your physician may also be requested to obtain a referral or pre-certification for your hospital visit.
- You will be asked to sign several documents, including:
- Acknowledgement that you have received a Notice of Privacy Practices
- Consent to Treatment and Financial Obligations
- Medicare Secondary Payer (MSP) Questionnaire(Medicare beneficiaries)
- Advanced Beneficiary Notice(some Medicare beneficiaries)—Advises you that the test/procedures performed may not be covered by Medicare. The purpose of the Advanced Beneficiary Notice is to let you know in advance that these services may not be covered and to advise you that you will be responsible for the Medicare reimbursement rate for these charges.
- Advance Directive: You are also asked about an Advanced Directive when you register for inpatient or outpatient hospital services. Formal Advanced Directives are documents written in advance of serious illness that state your choices for health care, or name someone to make those choices, if you become unable to make decisions. Medicare and hospital accrediting bodies (organizations that oversee the quality of care provided by hospitals) require we ask each patient, at each visit, whether or not the patient has a current Advance Directive. This could be in the form of a living will, health care power of Attorney, or both. Through these documents you can make legally valid decisions about your future medical treatment.
- Most insurance plans require that you pay a co-payment, co-insurance and/or deductible for your health care services (patient responsibility). In some instances, your insurance carrier may require a pre-certification for certain outpatient services that have been prescribed for you. This is the physician’s responsibility to obtain from your insurance company. If your physician has not obtained a pre-certification, your test or procedure may be cancelled or delayed.
Main Line Health representatives will present you with an estimate of your co-payment, coinsurance and/or deducible based on our understanding of your individual insurance coverage. It is our expectation that this co-payment, coinsurance, or deductible be made at time of service.
For your convenience we accept cash, check, Visa, MasterCard, American Express and Discover Cards.
- After the care or treatment is performed, the hospital’s billing office files a claim with your primary insurance organization for services. In many cases, payment is sent directly to your health care provider, not to you.
- If your insurance organization will not pay because of a problem with the information provided, the billing office tries to correct the information and re-files the claim.
- After payment is received from the primary insurance organization, the billing office will file claims with any secondary insurance organizations.
- When all insurance payments to the hospital have been processed and paid by your insurance company, you are billed for any remaining unpaid balance. You will receive a statement by mail. As a courtesy to you, a payment representative (who will clearly identify himself or herself and will ONLY ask you verifying information) will call you 30 days after mailing your first bill to determine if there are any matters which are unclear. We encourage our patients to use this service call to address any unanswered questions regarding the billing process.
It is important that you are familiar with your benefits and the extent of your medical coverage. We suggest that you contact your insurance carrier before scheduling an elective procedure and before services are rendered.
Most hospital visits involve both physician and hospital resources. Please be aware that physician charges are billed separately according to the terms of your insurance plan. A list of typical physician service organizations and contact information can be found on the Billing and Physician Group Contacts page. It is possible you will receive only one hospital bill, but several physician bills depending on the complexity of your care.
A special note to new and expecting parents
Most insurance companies require that a new child be added to the parent’s policy within 30 days of birth. Failure to do so could result in non-payment for the child’s hospital services by the insurance company. If this occurs, the parent/responsible party will be billed for the services. Please check with your insurance company to determine when they require a new child to be added to the policy.
Charity care policy
No patient will be refused emergency treatment at Main Line Health because of their financial status. Please see Main Line Health’s Charity Care and Financial Assistance Policy for additional details.