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Billing/Insurance Guide

Your Hospital Bill

Every patient who seeks medical care at McDonough District Hospital will receive care, regardless of their ability to pay. All patients are charged the same amount for services they receive regardless of their payer source. Because treatment plans may change during your stay, it is difficult to know your final total charges at the time of an admission or discharge from the hospital. A week or so after your visit, you will receive a statement summarizing the hospital services you received.

Public Viewing of Hospital Charges

These charges fall into two categories:

  1. A basic daily rate (for inpatients), which includes your room, meals, nursing care, housekeeping, linen services, and television.
  2. Charges for special services, which include items your physician orders for you, such as x-rays and laboratory tests.

Physician Fees

Your bill is only for hospital services, anesthesia, and radiology physician services. If you received services in the MDH Emergency Department, your hospital bill will also include the Emergency Room physician charges. If you have certain tests or treatments such as surgery or lab tests performed during your hospital visit, you and/or your insurance carrier will receive bills from both the hospital and independent physician(s) or professional groups. Bills that you receive from these physicians or professional groups are their fees for administering, interpreting and reading your tests and procedures. In addition to your primary physician, you may receive separate bills from pathologists, cardiologists, and other independent specialists that perform these services.

Independent physicians, including anesthesia and radiology physician services, and your personal physician, may not necessarily participate in the same contracts as the hospital making them “out of network” providers and which may have a higher out-of-pocket responsibility for you if they are “out of network.” Any questions about coverage or benefits available should be directed to your healthcare plan. If you have questions regarding any of your physician bills, please call the telephone number printed on their bill.

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, and hearing evaluations. Deductibles and co-payments are also the responsibility of the patient.

If you are scheduled for outpatient services, please bring your physician’s order and diagnosis with you or be sure that your physician has sent it to the hospital prior to your arrival. If Medicare does not cover the services ordered, you will be asked to sign a Medicare Advance Beneficiary Notice (ABN) to indicate that you have been informed of your payment responsibility.

Sometimes another insurance company should pay your medical bills before Medicare pays its share. Medicare requires hospitals to determine who pays primary so we can bill the correct insurance first. This requires us to ask you a set of questions called the Medicare Secondary Payor questionnaire for almost all visits. Medicare usually pays second in the following situations:

  • Your injury or illness happened at work. In this case your worker’s compensation insurance will pay first.
  • You worked in a coal mine and the Federal Black Lung Program will cover your illness.
  • You are a veteran and have Veteran Affairs benefits.
  • You or a family member are employed and have health insurance through that employer.
  • You are on Medicare because of kidney failure and have health insurance through a current or former employer.
  • You have been involved in an accident where there is other insurance to pay before Medicare.

If You Have Health Insurance

To help patients meet their financial obligations, we will file an insurance claim with your primary carrier (as well as most secondary insurances) in exchange for your assignment of benefits. To do this efficiently, you must present accurate and complete insurance information at the time of registration. We will request a copy of your insurance card upon registration. We also may need insurance forms that are supplied by your employer or insurance company. You will be asked to assign benefits from the insurance company directly to the hospital.

Insurance companies sometimes require certain procedures and tests to be authorized by them in advance or no benefits will be paid. Be sure and check with your insurance plan to know what needs to be approved.

We will do everything possible to expedite your claim; however, deriving benefits from an insurance policy is ultimately the primary responsibility of the insured. All commercial insurance companies will be allowed 45 days from the billing date to make payment on the claim. If payment is not received within 45 days, the guarantor will be expected to pay the account. You should familiarize yourself with the terms of your insurance coverage. Regardless of your health insurance carrier’s payment determination, you are responsible for payment.

You will receive a statement shortly after your insurance has finalized, advising you of any balance due from you. Unpaid balances, including all applicable deductibles, co-payments and any non-covered services are the responsibility of the patient and must be paid within 30 days upon receipt of the statement. If the account cannot be paid in full, payment arrangements must be established on the account by contacting the Financial Assistance Office.

If You Are a Member of an HMO or PPO

Your plan may have special requirements such as pre-certification for certain tests or procedures. It is your responsibility to make sure that 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. Please check with your plan if you are uncertain about your participation. Further, some physician specialists may not participate in your healthcare plan, and their services may not be covered by your plan. Payment for these services will be your responsibility.

If You are Covered by Medicaid

We will need a copy of your Medicaid card. Medicaid has payment limitations on a number of services and items.

If You Have No Insurance

Every patient who seeks medical care at McDonough District Hospital will receive care, regardless of their ability to pay. You may qualify for financial assistance. We are dedicated to finding or providing assistance to those in need. Through an interview process, our Financial Counselors can help determine if you may qualify for external financial assistance (i.e., Illinois Department of Public Aid) or internal financial assistance (McDonough District Hospital's various Financial Assistance Programs). This interview process may take place in person, over the phone, or by mail inquiry. Through the application process, you or your family members provide financial information to us so that we can determine if you qualify. Assistance can be extended to uninsured patients or insured patients whose coverage is inadequate and who do not have the ability to pay. Our assistance criteria are based on the guidelines set forth by the United States Department of Health and Human Services and are comparable to other area hospitals. Please note that you will continue to receive bills until your eligibility has been determined.

If You Were in an Auto Accident

If you are involved in an auto accident, you will be asked to provide us with the name, address, and auto policy information of the person responsible for the accident. We will file a claim on your behalf. If the auto insurance does not pay within a reasonable period of time (45 days), we will bill you or any other health insurance provided. Please remember that your health insurance may not pay claims where they feel another insurance may be primary.

If You Were in an Accident Involving a Third Party

If you are injured as the result of an accident, injury, or other cause involving a third party, the bill will be considered your responsibility. The hospital will not become involved in any third party liability cases. Litigation resulting from accidents may take months or even years. It is the patient’s responsibility and obligation to see that the hospital bill is paid promptly, regardless of any pending litigation resulting from an injury caused by a third party. If your insurance company will not make payment until the litigation is resolved, you will be personally responsible for the balance. The hospital may file liability liens against the patient and/or responsible party whenever deemed necessary to protect the interest of the hospital.

If You Were Injured at Work

If you are injured at work and your employer has recognized your injury as work-related, we will bill your employer or employer’s designated insurance carrier for charges incurred. Any balance disputed by your employer will be considered your responsibility.

If Your Account Becomes Delinquent

If your account becomes delinquent, it may be referred to a collection agency. Accounts placed in collection will be assessed a 25% late payment fee in addition to any attorney fees or court costs that may be incurred in an attempt to collect the debt.
An account is considered delinquent if:

  • Payment in full is not received within 30 days of your first balance due bill UNLESS:
    • A completed financial assistance application has been returned; OR
    • A 12-month payment plan has been arranged with the Financial Assistance office; OR
    • A signed extended monthly payment arrangement has been completed and returned.
  • The patient or family fails to cooperate in meeting prerequisites for determination of financial assistance.
  • The patient has indicated that they will not pay.
  • There is a default of payment arrangements previously established. Be sure to review the terms of your agreement to determine when account is in default.