A Guide to Bayhealth Billing

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2 A Guide to Bayhealth Billing All of us at Bayhealth Medical Center wish you or your loved one a pleasant experience and speedy recovery. We realize this can be a stressful time for you and your family. We particularly understand how frustrating it can be when you are in a hospital as an inpatient, outpatient, emergency room patient or receiving home care services, and you are not familiar with our billing processes. In this billing guide, we want to help you understand the issues involved in paying bills as well as the differences between bills you receive from Bayhealth and other providers. Because billing is separate for hospital charges, doctors fees and home care services, it is important that you take a moment to read this guide carefully. Once you do, be sure to keep it with your other financial or health records, as it will make a handy resource. Before Your Visit Please become familiar with your insurance plan(s) before your appointment. For each visit, remember to bring the following: 1. Photo identification; if photo identification is not available please provide two other forms of identification. 2. Health insurance card(s) 3. Signed doctor s requisition, authorization and referral forms. 4. Requested co-payment These items give us an understanding of your insurance coverage and are needed to bill your insurance accurately and timely. Bayhealth Medical Center is compliant with the Federal Trade Commission mandated guidelines on identity theft; please contact Bayhealth s Privacy Coordinator at for a copy of our policy if needed. Service may be postponed to protect your identification if proper identification is not presented at time of registration. On every visit we will always ask for your health insurance card(s) to ensure accurate billing. This may seem redundant but is necessary because insurance coverage often changes between visits. Arrival Time If you have been given an arrival time please make all efforts to arrive fifteen minutes before your scheduled time. Bayhealth will send statements to you after your insurance carrier has been billed and we have received payment or determination. You should receive an explanation of benefit from the insurance carrier detailing services provided and claim decision. You may request an itemized statement from our Billing Support Department, located at 522 State St. Dover, Delaware or by phone The toll free number is

3 Types of Bills Inpatient Bills Patients who are admitted to the hospital (inpatients) will receive multiple bills. One bill will be from the hospital. This bill includes charges for your room, medical supplies and services; hospital based doctors, and any tests or procedures that you may undergo, including x-rays. Physicians that provide services will bill separately for their service, such as Anesthesiologist, Private Practice Physicians, Radiologists, ED Physicians, Hospitalists, etc. Outpatient Bills Patients seen in an outpatient setting may receive multiple bills. Your outpatient center bill may include charges for your office visit and any tests or procedures that are done at the time of your appointment. For scheduling reasons, some tests or procedures may be performed at a later date and billed separately. You may also receive a bill from your doctor. Patients seen at more than one Bayhealth site for a single appointment may receive multiple bills. Emergency Room Bills Patients seen in an emergency setting will receive multiple bills. Your emergency bill may include charges for your visit as well as any tests or procedures that are done at the time of your visit. The emergency room physician that provided service to you will bill separately for these services. Subsequent visits (follow-up/rechecks) to the Emergency Room may result in additional charges; including additional co-insurance and/ or deductibles. Please refer to your Explanation of Benefits Manual for guidance. Disputes with the physician bill should be resolved with their billing company, which is not part of Bayhealth Medical Center; their phone numbers will be included on the physician billing. Home Care Bills Home care patients may receive a bill for services and/or products provided in their homes. The bill for Home Care services may include charges for visits from a Nurse, Physical Therapist, Occupational Therapist, Speech Therapist or Social Worker. You may receive additional bills from the provider of IV Therapy or Home Medical Equipment. Doctors Bills The bill from your doctor(s) will include the cost of medical and surgical care they provide, including review and interpretation of your diagnostic tests. You may receive multiple bills if more than one physician is involved in your case. Most doctors are independent practitioners and will bill you for their services i.e., reading x-rays, emergency room visits, etc. Bayhealth does employ doctors for Pathology, Oncology, and Clinics. If Bayhealth employs the doctors we will bill insurance or you for their services either under the name of Bayhealth Medical Center or Bayhealth Physicians. Billing inquiries to Bayhealth Physicians should be made to All other calls should be made to Billing Support numbers listed in the phone directory of this guide. Observation Bills Patients are placed in a normal inpatient setting; however they have not been formally admitted by a physician. Patients are typically in the hospital overnight, while the physician is waiting

4 for test results to determine treatment plans. If the patient s condition does not meet inpatient criteria they will be discharged. Your insurance company typically pays the hospital under the outpatient provisions of your insurance benefits. Payment Responsibility At the time of your admission, appointment or service, you will need to identify your insurance plan to your Bayhealth registrar. You may be requested to pay for the part of your hospital service or doctor(s) bills that your insurance plan does not cover or make suitable arrangements. This can include co-pays or deductibles. In some instances, you may be required to pay the full amount. As a rule, you should refer to your benefit guide before any hospital, clinic, or doctor s office visit to find out what is and is not covered under your plan, and whether you will be responsible for any part of the payment. Please note that our Patient Financial Services Department will file your claim directly with your primary and secondary insurance provider. If your insurance provider does not respond within 60 days of receipt, we may notify you and ask that you contact your insurance provider immediately. If you do not have your insurance card with you at the time of your appointment please provide the insurance information to our Billing Support Department or the toll free number If you do not notify us within 48 hours you may become responsible for the entire bill. Privacy At Bayhealth we are committed to the protection of your health information. The privacy rule permits us to use and disclose protected health information for payment purposes. Our Notice of Privacy Practices explains your rights and our responsibilities related to payment disclosures and other health information. You can pick up a copy of our privacy notice from any registration site or you may call the Privacy Coordinator whose number is listed on the last page of the guide. Collection Policy The hospital will take all necessary steps to collect the debt which may include the use of outside services, such as collection agencies, attorneys, etc. Patients with insurance or Medicare should receive the first invoice within seven (7) days of the claim being processed by the insurance company or Medicare. We will send a minimum of three (3) invoices to collect the amount due. In order to avoid your account from being advanced to outside services for collection you should either pay the balance off within four (4) months or make suitable payment arrangements with a Billing Support Representative. Accounts that are advanced to a collection agency may be reported to a Credit Bureau, which might affect your credit rating. Typically, the debt is reported to the Credit Bureau 31 days after the initial contact from the agency is made. This allows the debtor to clear the debt before the debt is reported.

5 Financial Assistance Our uncompensated care program is based on the Federal Poverty Guidelines for income, family size, and cash assets. Income must be verifiable. Our main source for this verification is the last filed tax return. Please contact our Billing Support Department, or the toll free number , if you believe you may qualify for assistance. Uninsured admitted patients will be screened for Medicaid eligibility. Dispute/Resolution Disagreement with our charges and reimbursement from insurance companies will occasionally surface. Our charges are established to meet the financial needs of the medical center. Normally prices for procedures and tests are adjusted annually. Supply charges are related to the cost to purchase the item. Drugs are based on average wholesale prices. When disputes arise with reimbursement from your insurance company we will often appeal their decision directly with the insurance company. However, often these disputes can be resolved more effectively when you contact the insurance company directly. We will be happy to assist you in appealing your claim with your insurance company. Please contact our Billing Support Department for assistance at or the toll free number Payment Methods You may pay by cash, personal check, traveler s check, money order, or debit/credit card. All Bayhealth sites accept American Express, Visa, Master Card, and Discover Card. ATM s are available on both campuses. We also offer financial counseling to help identify payment options. Payment Plans We can offer an interest-free payment plan to our qualified customers. These plans must be agreed upon with an authorized representative. The customer cannot pay an amount below the minimum and expect us not to advance the account to a collection agency. Please contact our Billing Support Department at or the toll free number to establish an interest-free payment plan. Customers that cannot meet the minimum payments may have their plan outsourced to another company for billing and collection. These plans will be outsourced at the discretion of Bayhealth Medical Center.

6 Glossary of Terms Advance Beneficiary Notice (ABN), some services are not payable by Medicare or other insurance companies. If your physician orders these tests you will be asked to sign an ABN. The ABN is notification that you understand that payment for the listed services will be your responsibility, if Medicare or your insurance company denies payment. If you do not sign the ABN the test should not be performed. If patient decides to receive the service but refuses to sign, the registrar will indicate on the ABN that the Patient Refused to Sign, and the patient will then be responsible for the bill. Authorization, many insurance companies require an authorization to be issued prior to tests or procedures being performed. Without an authorization the insurance company will not reimburse Bayhealth and it may be your responsibility to pay the bill depending on the contract between your insurance company and the hospital. Your physician will request the authorization from your insurance company. When authorizations cannot be verified at the point of registration, you have two options: 1) sign a letter accepting financial responsibility or 2) postpone the test until authorizations are verified. Consolidated Omnibus Budget Reconciliation Act (COBRA), gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. Co-Pays, this is a fixed fee that the subscriber must pay for their use of specific medical services covered by their plan. Deductibles, this is the amount not covered by the insurance plan for covered services. Explanation of Benefits (EOB), all insurance companies are required to send you an explanation of benefit form, which explains what they are paying and shows the amount you owe. This amount should be the same as the hospital bill. Hospitalists are licensed physicians that are assigned to hospital medicine, like emergency medicine, and is a specialty organized around a site of care (the hospital), rather than an organ (like cardiology), a disease (like oncology), or a patient s age (like pediatrics). Most hospitalists help manage patients throughout the continuum of care as well as organizing post-acute care.

7 Late charges, these are charges for services rendered to you that were omitted on the first bill. They are not charges being added to the account for late payment. Medicare Explanation of Benefits (EOB), Medicare sends summaries of their payments (EOB) to the patient on a monthly basis. These summaries may show a different amount than the hospital bill. This difference is created by the hospital s agreement with Medicare. Medicare payment is not based on the hospital charges but on Medicare s established payment schedule. Medicare determines the amount that is the patient s responsibility. This amount should correspond for the amount due from either the patient or your secondary insurance. Please keep in mind that if Medicare does not pay for a hospital service, often the secondary insurance company will also not pay for that service. There could be more than one EOB from Medicare per visit. Inpatient stays will usually generate a Part A and Part B EOB. Primary Care Physician (PCP), this is the doctor that you have chosen to treat you. This doctor will make referrals to specialists, obtain authorization for your treatment, and advise you where to go for treatment so that your insurance will pay. Referrals are recommendations made by your physician as to where to go for treatment. Referrals do not guarantee payments by the insurance company. Please see Authorization in this section of the Billing Guide. Secondary Insurance is a supplemental insurance plan that will pay some deductibles and co-pays after the primary insurance has paid. Secondary insurance cannot be billed until the primary insurance has paid or denied the claim. Medicare take home drugs are drugs that are usually self-administered by the patient, such as those in pill form, or are used for self-injection, and are not normally paid by Medicare. However, there are some self-administered drugs that are explicitly covered by Medicare.

8 Bayhealth Medical Center Provider Addresses Hospitals Kent General Hospital 640 South State Street Milford Memorial Hospital 21 West Clarke Street Outpatient Laboratory and Diagnostic Services Middletown Medical Center Outpatient Service Center 209 East Main Street Middletown, Delaware Dover Outpatient Imaging Center 540 South Governors Avenue Dover, Delaware Smyrna Clayton Medical Services 401 North Carter Road Smyrna, Delaware Outpatient Rehabilitation Center 560 S. Governors Avenue Dover, Delaware Harrington Outpatient Services Center 201 Shaw Avenue Harrington, Delaware Milton Outpatient Services Center 632 Mulberry Street Milton, Delaware Bayhealth Outpatient Imaging Center Eden Hill Medical Center 200 Banning Street, Suite 140 Dover, Delaware Milford Outpatient Imaging Center 1020 Mattlind Way Oncology Services Bayhealth Oncology Services 793 South Queen Street Dover, Delaware Bayhealth Oncology Services Milford Memorial Hospital 21 West Clarke Avenue Bayhealth Oncology Services Kent General Hospital 640 South State Street

9 Women s Centers Women s Center at Milford Memorial Hospital 200 Kings Highway, Suite Women s Center at Dover 540 South Governors Avenue Dover, Delaware WalkIn Medical Care WalkIn Medical Care 301 Jefferson Street Bayhealth s SleepCare Centers Milford Memorial Hospital 21 West Clarke Avenue Medical Office Building, Dover 540 S. Governors Avenue, Suite 101c, 1110 Forrest Avenue 1407 Foulk Road Wilmington, Delaware Wrangle Hill Road Bear, Delaware Carter Drive Middletown, Delaware Lee Avenue Georgetown, Delaware Bayhealth Medical Group Bayhealth Medical Associates of Milford Preeti Gupta, MD Adrian Morris, MD 305 Jefferson Avenue Office: /Fax: Bayhealth Medical Associates of Milton Elisa Montross-Lopez, MD 630 Mulberry Street Milton, Delaware Office: /Fax: Bayhealth Women s Care Associates of Milford Arthur Jones, DO Noel Anupol, MD Miaohou Xu, MD Stacy Kemp, RNC, WHCNP 517 South dupont Highway /Fax: Bayhealth Women s Care Associates of Milton Miaohou Xu, MD 630 Mulberry Street Milton, Delaware /Fax: Maternal Fetal Medicine/Perinatology Garrett Colmorgen, MD 640 South State Street, 6th Floor /Fax:

10 Bayhealth Plastic and Aesthetic Surgery Center Dimitrios Danikas, MD, FACS 517 South dupont Highway /Fax: Wolf Creek Boulevard Bayhealth Endocrinology of Milford Sonal Pathak, MD, CCD 305 Jefferson Street /Fax: Bayhealth ENT Stephen Cooper, MD, FACS 826 S. Governors Avenue /Fax: Masten Circle /Fax: Bayhealth ENT of Georgetown William A. Wood, MD dupont Boulevard, Suite 202 Georgetown, Delaware /Fax: Wolf Creek Boulevard Bayhealth Family Practice of Dover Patience A. Ankomah, MD 200 Banning Street /Fax: Bayhealth Medical Associates of Harrington Vincent Lobo, DO, DACFP Andrew Nash, DO, FACP 205 Shaw Avenue Harringotn, Delaware /Fax: Bayhealth Medical Center does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment. Contact Person/Section 504 Coordinator: Jo Ann Davis Telephone Number: (302) TDD or State Relay number: Bayhealth TDD # is

11 Phone Directory Bayhealth Billing Support Kent General Hospital Milford Memorial Hospital Bayhealth Guest Relations Kent General Hospital Milford Memorial Hospital Bayhealth Financial Counselors Kent General Hospital Milford Memorial Hospital Bay Anesthesia Bayhealth Home Care Billing Medicare Billing Delmarva Emergency Physician Billing Kent Diagnostic Radiology Associates Anesthahealth Milford Diagnostic Imaging Milford Anesthesiologists Ambulance Services Hart to Hart Prime Care Christiana Care Helicopter Service Bayhealth Physician Offices Bayhealth Privacy Coordinator

12 Bayhealth Medical Center does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment. Contact Person/Section 504 Coordinator: Jo Ann Davis Telephone Number: (302) TDD or State Relay number: Bayhealth TDD # is N# /2012