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| Frequently Asked Questions about
Billing |
e-Pay |
Do you
offer payment arrangements?
Yes, payment arrangements
may be made by contacting the Customer Service Department via PMD (Preferred
Medical Deposit) Monday through Friday 8:00 a.m. to 4:30 p.m. (Central Time), by
calling PMD at 1-800-777-8645.
Why does
my invoice show PMD (Preferred Medical Deposit) and not St. Mary Medical
Center?
PMD is St. Mary Medical Center’s self-pay
billing division for all processing and follow up of patient balances.
Why do I receive separate bills from the
hospital and from the physician?
When services are
provided by a physician specialist (emergency room physician, cardiologist,
pathologist, radiologist, etc.), he/she is required by law to submit a bill for
their individual services separate from the hospital's bill.
Will you bill my primary and secondary
insurance carriers?
Yes, St. Mary Medical Center will
submit the bill to your insurance carrier and will assist when problems arise.
You are requested to supply the pertinent billing information at the time of
scheduling or registration. You must also provide any referral(s) if
applicable for the specific date of service.
Why am I receiving a request for insurance information when I
provided it at the time of service?
Some insurance
providers will send a questionnaire that must be completed in a timely manner
for your claim to be processed and payment issued to your providers.
Insurance companies are required to update their patient information and
determine eligibility. This process is called a COB or Coordination of
Benefits. Please complete and return this form as soon as you
receive it.
Is there any help available
that allows me to better understand my billing
statement?
Yes, you are welcome to contact our Customer
Service department Monday – Friday between the hours of 8:00 a.m. and 4:30 p.m.
at 215-710-6500.
Do you offer assistance
for financial or medical hardship?
Financial Assistance
is a community benefit offered by St. Mary Medical Center. Applications
can be obtained by calling our Customer Service department Monday – Friday
between the hours of 8:00 a.m. and 4:30 p.m. at
215-710-6500.
What is the difference
between medical assistance and financial
assistance?
Medical assistance is a program offered
through the state and must be applied for by our on-site advocate, HRSI
(Healthcare Receivable Specialists Inc.).
Why is a service billed as an outpatient service when I spent the
night in the hospital?
For an account to be billed as an
inpatient service there must be a physician order. The physician who ordered
your services determined that your condition did not meet the requirements for
an inpatient admission. The physician's written order dictates whether we bill
as an inpatient or outpatient.
Why is a
service billed as an inpatient service when I did not spend the night in the
hospital?
For an account to be billed as an inpatient
service there must be a physician order for admission. The inpatient
determination is driven by the physician order to admit and his/her expertise
that the level of care necessitated an inpatient status.
Why did my insurance carrier deny the
claim?
Your insurance carrier may
deny the claim for one or more reasons. It is always best to call member
services at your insurance carrier to discuss your account. Some common reasons
are:
-
You were not covered by your plan on the date
of service.
-
The patient cannot be identified.
-
The primary physician did not issue a
referral.
-
The service was not authorized.
-
The service that you received was out of
network.
-
The balance is due to the patient's
deductible and/or co-pay.
-
The account denied as "other insurance
carrier is primary.”
-
The insurance premium was not met
-
Your insurance carrier deemed the service not
medically necessary
-
The COB (Continuation of Benefits)
questionnaire was not returned or was incomplete.
What is a
deductible?
Deductibles are provisions that require the
member to accumulate a specific amount of medical bills before any benefits are
paid. Once the patient/insured has met their deductible, the insurance carrier
usually pays a percentage of the bill. The patient may be liable for the unpaid
percentage.
What is co-insurance or
co-pay?
Co-insurance and/or co-pay is the portion due by
the patient and/or insured. Managed care carriers charge co-pays for varied
services. For example, emergency room visits, specialist, physical therapy and
mental health services.
Why did the
insurance carrier only pay part of my bill?
Dependant on
your individual plan, insurance carriers require you to pay a deductible and/or
co-insurance. Please refer to your insurance plan booklet for more details or
call the phone number listed on your insurance card for more details.
Why do I need to call the insurance
carrier if they do not pay the bill?
The Business Office
of St. Mary Medical Center will make every effort to resolve the account balance
with your insurance carrier. Occasionally, we will be unable to resolve the
issue with your carrier and will need your assistance.
What should I do before coming to St. Mary Medical Center for
services?
Read your insurance booklet to be sure you
have followed all the guidelines for referral and authorizations, or call member
services at the phone number listed on your medical card at your insurance
carrier for assistance. Failure to follow your plan requirements may result in
greater out-of-pocket expenses. Your primary care physician plays a very
important role in this process. Should you receive a written referral or a
verbal authorization number, please provide us with this information at time of
scheduling or at registration.
I belong
to a managed care plan but needed to be seen in the emergency room, what should
I do now?
If you did not contact your primary care
physician or your insurance plan before you came to the emergency room after
receiving services, you may need to contact them within 24 hours to explain the
reason of your visit. Please refer to your insurance plan booklet or call the
phone number listed on your insurance card for more
details.
How do I know if my health plan
requires a referral or pre-certification for a
service?
Your benefit booklet, provider directory, or
physician’s office should provide this information for you. If not available,
call your member service unit at the insurance carrier and they should be able
to help you. Employees can speak with their benefits
coordinator.
What should I do when I
relocate or change my address and/or telephone
number?
When your personal information changes you
should always notify the hospital and/or medical providers of the change by
contacting the Customer Service Department at 215-710-6500.
What should I do when my insurance
carrier/plan has changed?
When you experience any
changes to your insurance coverage, you should contact all the providers that
offered medical services to you. Changing coverage includes staying with the
same insurance company but choosing a different benefit
plan.
What should I do if my health plan
includes St Mary Medical Center as a participating provider, but I receive an
explanation of benefits stating I am out of
network?
Consult your health plan's member services
unit.
What should I do when my visit to
the emergency room is a result of an automobile
accident?
When you are involved in an automobile
accident, contact the adjuster at your automobile insurance carrier immediately.
The adjuster will give you a claim number specific to the accident and request
that you complete and return a questionnaire that describes how and when the
accident occurred. You may receive a questionnaire from your insurance
company. The questionnaire must be returned promptly and notably to your
insurance carrier, before any benefits will be paid out. Telephone the Customer
Service department of St. Mary Medical Center Monday – Friday, 8:00 a.m. to 4:30
p.m. at 215-710-6500 to offer the appropriate insurance information for billing.
Also, be sure to provide any medical insurance information including a referral
or authorization, if this is a requirement of your health insurance carrier in
the event your auto insurance is exhausted. This will enable us to bill your
health insurance carrier for any remaining balances due after your auto
insurance carrier has paid their portion.
What should I do when my visit to the emergency room is a result
of an injury incurred on the job?
Telephone the Customer
Service department of St. Mary Medical Center Monday – Friday, 8:00 a.m. to 4:30
p.m. at 215-710-6500 with the name of the employer's workers compensation
insurance carrier and the appropriate insurance information for billing. Also,
be sure to provide any medical insurance information so that we can bill your
medical carrier if the service is denied by the workers compensation carrier.
What should I do if I received a medical
service at St. Mary Medical Center during a period when I did not have
healthcare insurance?
If you received medical services
during a time when you did not have health insurance, contact the Customer
Service Department of St. Mary Medical Center at 215-710-6500 immediately. A
service representative will inform you of the varied options available.
What insurance carriers participate with
St. Mary Medical Center?
- AARP
- Aetna
- Amerihealth
- Americhoice
- Blue Cross
- Bravo Health
- Health Partners
- Independence Blue Cross
- Keystone Mercy
- Medicare
- Medicaid
- Oxford Health Plan
- All Auto Insurance Carriers
- All Workers Compensation Carriers
- Most Commercial Carriers
What are the telephone numbers to Associated
Professional Providers?
|
Middletown Anesthesia
Team Health
Radiology Affiliates
Princeton Radiology
Oncology |
888-216-2675
800-837-9910
215-710-2279
609-566-5755
|
Can I call for a price quote prior to service?
Due to the complexity of
some services provided at the time of service, we may or may not be able to
provide a cost estimate.
Who do I call if I
do not understand my Medicare plan?
If you have questions about your Medicare plan, contact them by calling
the phone number listed on your Medicare card or by dialing
1-800-633-4227. You may also log on to www.medicare.gov for
more information.
Why am I required to give my Medicare ID if I have a Medicare
replacement plan?
Medicare requires
St. Mary Medical Center to notify them when you receive care regardless of your
status.
When will Medicare not pay for
a test?
Medicare pays only for a test that is considered
medically necessary. If the diagnosis given by your doctor is not one of the
diagnoses Medicare will accept for the test, the test will not be considered
medically necessary and Medicare will not pay for the test.
If Medicare says the test is not medically necessary, then why perform it?
Your doctor has made a medical judgment that you need the test. When your
doctor says a test is medically necessary they consider your personal history,
the medications you are taking and generally accepted medical practices.
Why do you want me to
sign an ABN (Advance Beneficiary Notice)?
We ask
patients to sign an ABN whenever Medicare appears likely to deny for payment for
a specific service. Medicare requires that we provide patients with a written
notification whenever it is likely that you will be responsible for the bill.
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