Not sure about what your insurance covers? Having a hard time figuring out your hospital bill? Capital Region’s Revenue Cycle Management team has prepared answers to frequently asked questions about insurance, billing, financial assistance and related topics.
If you need more information, we are here to help. Please call 573.632.5029, or visit our patient account representatives at either location.
Most insurance companies require patients to pay a portion of their doctor’s visit or hospitalization costs. This is called a co-payment or deductible, and these payments are generally made before your appointment, procedure or admission. If these payments are not made, we may have to reschedule your appointment. If you have questions when you come in for care, the financial counselor in that area can help.
These are insurance costs sharing terms and are all amounts you may have to pay.
- Deductible is the amount you pay before your insurance begins to pay, and this may not apply to all services.
- Coinsurance is your share of the costs and is usually figured as a percentage for the total charge for the service.
- Copay is a fixed amount you pay. usually when you receive the service, and this amount can vary by the type of service.
Many insurance plans require prior authorization (sometimes called pre-certification) for services such as inpatient surgery. When Capital Region schedules these services, we check with the patient’s insurance company. If they do not approve the service, we notify the patient before the services takes place. Patients who decide to proceed with the service are responsible for payment.
When your physician places you under observation status, this means our clinical staff will closely monitor you for the next several hours. Your observation period will be used to determine if you can be sent home or need to be admitted as a hospital inpatient. Observation status includes medically reasonable and necessary services such as ongoing short-term treatments, assessments and close monitoring, tests and certain procedures. Observation status for 24-48 hours is generally covered by healthcare plans. If it extends beyond that, you may be financially liable for the additional care. Insurance companies require that we bill all observation status care as an outpatient service. If you have any questions about how your healthcare plan treats observation services whether these are covered as outpatient care, please contact your insurance company.
If you are a Medicare subscriber, observation status is not considered a hospitalization and does not affect your Medicare Part A benefits. No hospital days are used, and the Part A deductible is not required. This also means that observation status does not count toward the three-day qualifying stay requirement for admission to a skilled nursing facility.
Observation status is covered by Medicare Part B. There is an annual deductible and co-pay for these services. In addition, you should know that while you are in the hospital during an outpatient observation period, Medicare does not pay for “self administered drugs,” such as oral medications, eye drops, creams, ear drops, ointments, inhalers, suppositories and insulin - even if a nurse administers them to you. If you have questions about observation status services covered by Medicare, please call 1-800-MEDICARE (1-800-633-4227).
Uninsured patients automatically receive a 65% discount based on the average discount given to Medicare and commercially insured patients. It does not disqualify you for financial assistance. Our uninsured patients will never be charged higher than the above average, which will be reviewed and updated yearly. There are some charges not covered under this discount and policy. Services not billed by Capital Region Medical Center include:
- Emergency room physician services.
- Cosmetic surgery (elective).
- Outside labs (Boyce and Bynum and Quest).
- Radiology professional fees (reading) are covered under the clinic uninsured discount.
- Anesthesia professional fees are covered under the clinic uninsured discount.
- Capital Region Physicians clinic services.
Financial assistance is based on need and determined by the Federal Poverty Level assigned by the Department of Health and Human Resources. This would include income and number of family members. Financial need does not consider age, gender, race, social, sexual orientation or religious affiliation. Capital Region Medical Center provides emergency medical care regardless of a person’s ability to pay.
Medicaid and other public programs:
For inpatient services, we have a patient advocate on site that can assist you in applying for these programs. You can also call 573.632.5188 and leave a message, and the patient advocate will return your call to assist.
For outpatient services, we can give you information on who is eligible and how to apply. Stop by our patient advocate office located in Outpatient Registration, ER Registration and in the Physicians Office Building, or call 573.632.5131 to make an appointment.
Financial Assistance Program:
If you are not eligible for Medicaid, you may qualify for our financial assistance program. Your household income and the amount of your medical bills are taken into consideration in determining if you qualify. Our financial assistance is based on 200% of the Federal Poverty Level.
Payment arrangements or interest free loans:
We have many options available to assist you in resolving your account(s). They include an in-house payment plan for up to six (6) months and an interest free bank loan program for extended payments through Commerce Bank. Contact our office at 573.632.5029 to discuss your needs.
Patients are expected to cooperate with Capital Region Medical Center’s financial assistance application process. This may require purchasing health insurance if financially able, or applying for government programs. Eligibility for financial assistance may be restricted to our nine (9) county coverage areas. In cases when a patient appears eligible for financial assistance, but no evidence is available, Capital Region Medical Center will use presumptive scoring software.
You must complete a financial assistance application. You will have to be prepared to supply information about your household income and expenses. Documents that must be provided include (not limited to):
- Checking and savings account statement (last three months).
- Verification of income (last two months).
- Last year income tax return or non-filing letter.
For a free copy of the application, click here, or call our office at 573.632.5029. You may also visit any registration location to pick up a copy. These applications are available in English and en espanol. If another language is required, contact our patient advocate at the above number for assistance.
Yes. Help is available for Medicaid, financial assistance and interest free bank loans.
When we receive the completed application with all required documents, the turnaround time is 14 days. You will be sent bills during this time. We cannot approve an incomplete application.
No. One application will cover all of your active outstanding accounts.
An Advance Beneficiary Notice (ABN) is a form for you to sign that lets you know beforehand that you may have to pay for a test your doctor has ordered.
By law, Medicare will only pay for services that are determined to be “reasonable and necessary.” Capital Region believes that doctors are in the best position to know what their patients need. However, in some cases, Medicare will not pay for tests even though the doctor believes they are necessary. If Medicare does not pay for these services, then you will be responsible for the balance.
Although Medicare pays for most lab tests and x-rays, it will not pay for some tests under certain circumstances. When that happens, Capital Region must ask the patient to pay for these services.
The reason you are being asked to sign an ABN now is that we believe, based on the information we received from your doctor, that Medicare will deny payment for your test. Medicare requires that we notify you in writing whenever it is likely that you will have to pay a bill.
Medicare only pays for tests that it considers to be “medically necessary.” Most tests are medically necessary only under certain circumstances, depending on the patient’s diagnosis. For instance, Medicare does not pay for physicals. Some tests have limits on how often they can be performed, and Medicare will only pay for a certain number of tests over a specific period of time. To find out if your test or service is covered you can go to http://www.medicare.goc/coverage/your-medicare-coverage.html.
If you have any questions, feel free to discuss this with your physician or financial counselor.
A copy of our billing and collection policy, which describes the actions that Capital Region may take in the event of non-payment, is provided for free upon request.