What a Hospital Bill Covers
Your hospital bill covers the cost of your room, meals, 24-hour nursing care, laboratory work, tests, medication, therapy and the services of hospital employees. You will receive a separate bill from your physicians for their professional services, and you may also receive separate bills from the radiologist who reads your scans, from the pathologist who works with your cultures or a biopsy in the emergency room, etc. If you have questions about these separate bills, please call the number printed on each statement.
As a courtesy, the hospital submits bills to your insurance company and will do everything possible to expedite your claim. Your policy is a contract between you and your insurance company, and you have the final responsibility for payment of your hospital bill. If you choose Clinton Memorial Hospital (CMH) for your care and we are an out-of-network facility according to your insurance, it's your responsibility to contact your insurer, as you may need to notify them of your visit in order for your services to be covered. The same applies if your physician refers you to CMH and your insurer considers us an out-of-network facility.
Coordination of Benefits
Coordination of benefits, referred to as COB, is a term used by insurance companies when you're covered under two or more insurance policies. This usually happens when both spouses are listed on each other’s insurance policies or when both parents carry their children on their individual policies, or when there is eligibility under two federal programs. This can also occur when you're involved in a car accident and have medical and/or liability insurance through automobile insurance.
Most insurance companies have COB provisions that determine who is the primary payer for medical expenses. This prevents duplicate payments. COB priority must be identified at admission in order to comply with insurance guidelines. Your insurance may request a completed COB form before paying a claim, and every attempt will be made to notify you if this occurs. The hospital cannot provide this information to your insurance company. You must resolve this issue with your insurance carrier in order for the claim to be paid.
This hospital is an approved Medicare provider. All services billed to Medicare follow federal guidelines and procedures. Medicare has a COB clause. At the time of service, you will be asked to answer questions to help determine the primary insurance carrier paying for your visit. This is referred to as an MSP questionnaire and is required by federal law. Your assistance in providing accurate information will allow us to bill the correct insurance company.
Medicare deductibles and co-insurance may be covered by your secondary insurance. If you don't have secondary insurance, you will be asked to pay these amounts or establish a payment plan. If you're unable to pay these amounts, we will help you determine if you qualify for a state-funded program.
We will need a copy of your Medicaid card for the current month. Medicaid has payment limitations on a number of services and items. For example, Medicaid doesn't pay for the cost of a private room unless medically necessary. Additionally, some plans may have deductibles and co-pays that you're responsible for.
As a service to our customers, we will forward a claim to your commercial insurance carrier based on the information you provide at the time of registration. It's very important that you provide all related information, such as the policy number, group number and correct mailing address for your insurance company.
For Self-Pay Patients
Patient Financial Services will send statements for payment of self-pay accounts. You will receive two to three billing statements and two to three telephone calls over a 90-day period for us to obtain a payment or to set up payment arrangements. If payment arrangements are not established and no payment is made during the 90-day period, the account will be placed with a collection agency. If you need an itemized statement or if you have any questions regarding your billing statement, please contact Patient Financial Services at 937.382.9593.