Healthcare Billing Guide:

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Healthcare Billing Guide:"

Transcription

1 Healthcare Guide Healthcare Billing Guide: Strategies to Master Insurance and Billing Published by

2 Tips on Understanding Your Medical Bill 1 Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 2

3 Tips on Understanding Your Medical Bill In these turbulent economic times, consumers are becoming savvier spenders and healthcare is no exception. But paying for healthcare services isn t as easy as paying for other necessities like groceries or utility bills. Modern healthcare plans are incredibly complex, and for the average patient figuring out a medical bill can be a daunting task. Mark Rukavina, executive director of the Access Project, a nonprofit based in Boston that works to improve health and healthcare access, said one of the things his organization does is help patients understand their medical bills and what they owe to healthcare providers. In general, I think healthcare bills are confusing in part because when you have a procedure, you may be billed by a hospital and a specialty doctor or a physician group separately, says Rukavina. Know the Process for Better Outcomes Here s how the medical billing process works. After your scheduled doctor s appointment, surgery or other medical procedure, your physician submits a bill, or a claim, to your insurance company, Medicare or other insurance provider, for the services that you received during your hospital stay or doctor s appointment. The insurer then determines if and by how much it will reimburse your doctor or hospital for those services. When an insurance company reimburses a healthcare provider, the insurer typically sends a patient an Explanation of Benefits, also known as an EOB, which lists what services the insurance company is paying the doctor or hospital for and what services it is not paying for. The important thing to remember is that an EOB is not a bill. While many insurance companies send EOBs, not all of them do. Instead, you might receive a list of services performed once you leave a doctor s office or testing site. Not all doctors offices send statements. You may receive this document, an EOB or both. The most important document, of course, is the bill the doctor s office or health facility sends you. This will often come in the mail after the EOB and will reflect the charges that you owe once your healthcare provider has submitted a claim to your insurance company. The following are the main parts of your medical bill: Statement date: The date the physician s office, hospital or other health care provider printed the billing statement. Previous statement balance: The total amount of unpaid medical services before you received your current statement. If this is your first time visiting a certain doctor or other healthcare provider, or if you have no outstanding balance to your current healthcare provider, this column will appear as.00. Description: The list of services you received from your doctor or other healthcare provider. Account balance: The amount of money you owe to your healthcare provider. Once look over your bill, you ll want to compare it to your statement of services you received from your healthcare provider or the EOB you received from your insurance company. Check your bills for things like whether the dates on the bill and EOB match up and whether your insurance provider has paid your healthcare provider already. If more than 60 days have passed since your appointment or procedure and your insurer still hasn t paid your healthcare provider, you Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 3

4 Tips on Understanding Your Medical Bill should contact your insurance provider at once. For patients and their caregivers like patient advocates who have trouble managing their healthcare expenses, Wayne Messer and Associates, a financial services firm in the Chicago area, suggests that consumers consider using a computer software program, such as Intuit s Quicken Medical Expense Manager. If you can t pay the entire balance of a bill all at once, most hospitals and other healthcare providers can help you set up a monthly payment plan. Many states also have laws that protect consumers against certain debt collection and billing policies. Families USA, a consumer advocacy organization based in Washington, D.C., has compiled a list of consumer protection legislation that various states have passed: The organization has also published a guide for patients struggling with medical, which can be downloaded here: coping-with-medical-debt.pdf. As a resource, download an example of a medical bill from resource/resmgr/pdf_resources/medical_billing_example.pdf. Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 4

5 Top 7 Insurance Billing Errors, and How To Avoid Them 2 Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 5

6 Top 7 Insurance Billing Errors, and How To Avoid Them Costs of healthcare services and insurance plans are becoming increasingly more expensive not to mention much more confusing but there are ways to find savings and spot inaccuracies on your medical statements if you spend enough time reviewing your bill. A June 20 report by the American Medical Association found that commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of two percent compared to last year. The increase in overall inaccuracy represents an extra 3.6 million in flawed claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the U.S. healthcare system. The report estimates that eliminating health insurer claim payment errors would save $17 billion nationwide. You can catch or avoid medical these billing errors by reviewing your healthcare claims whenever you receive them. Often physicians offices and hospitals may not have the time to review your medical bills in-depth. But as a patient advocate (whether your own or another s), you have a right to follow up on your medical bills and ask questions about any charges that don t seem correct. Here s a list of some of the most common inaccuracies in medical billing and claims processing. Services rendered: Are you aware of all the services that you received or medications you were given during a hospital physician s visit? Check your bill to make sure you were not billed for a service or medication that you did not receive. Double billing: Were you charged for the same service twice? Make sure you know what tests, procedures and medications you received at the time of a hospital or doctor s visit. Compare your knowledge to services outlined on the bill to ensure accuracy and prevent duplicate billing. Length of stay: Do you remember when you admitted to and discharged from the hospital? Compare those dates with the ones on your medical bill and contact the hospital if there is a discrepancy. False room charges: What kind of room did you stay in? Was it private or semi-private? Many hospitals now have plenty of private rooms, but if you shared a room with another patient, make sure you were not charged for a private room. Keyboard error: As hospitals and other providers move to electronic health records, most medical documentation is now completed on a computer by physicians, nurses and other staff members. But just because this process is computerized does not mean it is free from error. A typing error could cost you hundreds or thousands of dollars for a service that you did not actually receive. Review your bill for these types of errors. Operating room time: Hospitals or outpatient facilities may document more time that was spent in the operating room than was actually used. You have the right to compare this time to the records documented by your anesthesiologist. Canceled orders: Sometimes a physician or other healthcare provider may initially order you a test, procedure or other service and cancel it later if it is not needed. Again, make sure you were not charged for a service that you did not receive. Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 6

7 How To Appeal an Insurance Claim Denial 3 Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 7

8 How To Appeal an Insurance Claim Denial If an insurance company has denied payment for a patient s claim for a certain medical service, it may be necessary for the patient to appeal that denial. Any claim denial can be appeal by a patient but patients first need to familiarize themselves with the process. First, patients should contact the health insurer through the customer service line and explain the nature of the claim and the denial. If the issue cannot be resolved over the phone, the insurance plan will likely require the patient to submit an appeal in writing. Patient advocates can play a role in helping patients through this process if they re unfamiliar with how to write an appeal letter. Here are some easy steps to appeal a health insurance claim denial: 1. Read over your health insurance policy. Make sure you know what healthcare services are covered by your insurance and which are not. Having a firm understanding of what your insurance policy covers is the first and most important step when trying to appeal a claim denial. 2. Call your insurance company to determine what documentation you will need to appeal the claim denial. Keep a log of who you talk to, what they say and the steps you will need to take to carry out the appeal. Also note the date and time of your call, the length of the call and any other details of the conversation. 3. Write the appeals letter, indicating today s date and date of service, claim number, your member or subscriber identification number, group or policy number, amount of charge and a description of the medical service or services you received and the denial. Make sure to indicate what it is you are actually requesting. You letter should be concise and easy to read and understand. Include copies of important information like medical bills, documents for the appeals process and records of the steps you took before sending the appeals letter. 4. Before sending your letter, have your physician or a patient advocate help you with your appeal. Along with your letter and other documents, include any other supporting documents from healthcare providers like medical records, progress reports or other health reports that could strengthen the likelihood of winning your appeal. 5. Identify the address to send an appeal letter. The appeals address may be different that the insurance company s headquarters or the address to which the claim was initially submitted. 6. Send your letter through the mail and request a return receipt so you can prove that you mailed the appeal letter in a timely fashion. 7. Follow up with your insurance company. The appeals process can take weeks and even months, so call or your insurance company often to check on the status of your appeal. Make sure to take notes of each time you try to contact your insurer. For more guidance on how to craft your appeal letter, check out these sample letters: Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 8

9 Insurance Gaps Prove Dangerous for Diabetics 4 Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 9

10 Insurance Gaps Prove Dangerous for Diabetics Interruptions in health insurance coverage can mean irregular and incomplete care for diabetes patients, according to a new study. When patients with diabetes have less coverage or go in and out of the health insurance system, they are less likely to receive the screening tests and other healthcare services they need to treat the disease. A new Kaiser Permanente study released Jan. 4 found that this is true even when patients receive free or reduced-cost medical services at federally funded safety net clinics. Our study shows that patients need continuous health insurance coverage in order to ensure adequate preventive care, even when that care is provided at a reduced cost, Dr. Rachel Gold, lead author and investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., said in a Kaiser press release. Many services at safety net clinics or community health centers are free, but some diagnostic tests and other services require a co-pay, which are typically covered by Medicaid. But for patients who lose their Medicaid coverage, testing is often delayed because they can t afford the co-pay. The Kaiser Permanente study surveyed 3,384 diabetes patients receiving medical care from 2005 to 2007 at 50 federally qualified health centers in Oregon. These community health centers provide free or reducedcost care to low-income patients whether or not they have health insurance. More than half the patients included in the study 52 percent had continuous health coverage when the study began in 2005, most often provided by the state s Medicaid program. Another 27 percent had no insurance, and 21 percent had interrupted coverage, during the three-year period of the study. Patients with private insurance were not included in the study. Most patients included in the study were aged 19 to 65 years; there were more women than men; about one-third were Hispanic; and almost three-fourths of the study participants were from households below the federal poverty level. Researchers looked at patients electronic health records to determine whether they received four services recommended at least once a year for sufferers of diabetes. Those four services included a lipid test for high cholesterol, a flu vaccine, a test that measures blood sugar levels and a urine test that can detect kidney damage. Out of the patients studied, 48 percent with uninterrupted insurance coverage received at least three lipidscreening tests at one of the study clinics from 2005 to 2007; 25 percent with continuous coverage received three or more flu shots; 72 percent received three or more screenings for blood glucose; and 19 percent received three or more screenings for kidney damage. Among the patients with partial insurance coverage during the study period, 44 percent had coverage for 80 percent to 99 percent of the three-year study period; 26 percent had coverage for 60 percent to 79 percent of that time; 9 percent had coverage for 40 percent to 59 percent of the time; 12 percent had coverage for 20 percent to 39 percent of the time; and 8 percent had coverage for 1 percent to 19 percent of the study period. In almost all cases, diabetes patients with no coverage and those insured for 1 percent to 99 percent of the study period received significantly fewer recommended health services than patients with continuous health insurance coverage. Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 10

11 Notably, the study showed no increase in services received as insurance coverage increased. Instead, all patients with irregular health cover were equally vulnerable to missing services, compared to the continuously insured. The study concluded that safety net clinic patients need both access to primary care and continuous insurance in order to receive proper preventive care. The study was funded in part by the National Institutes of Health and findings published online in the Journal of the American Board of Family Medicine. Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 11

12 Healthcare Billing Guide: Strategies to Master Insurance and Billing patientadvocatetraining.com 12

Understanding Your Medical Bill

Understanding Your Medical Bill Understanding Your Medical Bill After you visit a provider, you ll typically receive a bill telling you how much you have to pay. Providers can include healthcare professionals, hospitals and other types

More information

Reading an Explanation of Benefits

Reading an Explanation of Benefits Reading an Explanation of Benefits Quick Reference Guide Created by: Your urgent care dentist. www.emergencydental.com Anatomy of an EOB An Explanation of Benefits (EOB) is NOT a bill. It is a summary

More information

AARP S MEDICARE GUIDE FOR FAMILY CAREGIVERS

AARP S MEDICARE GUIDE FOR FAMILY CAREGIVERS AARP S MEDICARE GUIDE FOR FAMILY CAREGIVERS CONTENTS 5 About Medicare 7 A Little More About Your Choices 8 Medicare Prescription Drug Coverage 9 Where to Start 14 Medicare Glossary 2015. Reprinting with

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Kaiser Permanente Senior Advantage Essential Plus plan (HMO) offered by Kaiser Foundation Health Plan, Inc., Hawaii Region Annual Notice of Changes for 2015 You are currently enrolled as a member of Kaiser

More information

A CONSUMER'S GUIDE TO CANCER INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE

A CONSUMER'S GUIDE TO CANCER INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE A CONSUMER'S GUIDE TO from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE IMPORTANT INFORMATION WHAT IS? Cancer insurance provides benefits only if you are diagnosed with cancer, as defined

More information

I Have Health Insurance! Now What?

I Have Health Insurance! Now What? I Have Health Insurance! Now What? A Guide to Using Your Private Health Insurance Plan Brought to you by: Congratulations on Your New Health Plan! This guide is an overview of private insurance plans and

More information

Annual Notice of Changes for 2016

Annual Notice of Changes for 2016 Kaiser Permanente Senior Advantage Core (HMO) offered by Kaiser Foundation Health Plan of Colorado Annual Notice of Changes for 2016 You are currently enrolled as a member of Kaiser Permanente Senior Advantage

More information

MEDICARE SUMMARY NOTICE

MEDICARE SUMMARY NOTICE How To Read Your MEDICARE SUMMARY NOTICE THIS BOOKLET SHOWS EXAMPLES OF WHAT YOU MAY SEE ON YOUR MEDICARE SUMMARY NOTICE (MSN) AND HELPS YOU UNDERSTAND HOW TO READ YOUR SUMMARY NOTICE. Your Medicare Summary

More information

A Guide to Health Insurance

A Guide to Health Insurance A Guide to Health Insurance Your health matters. A healthier you makes a healthier Cleveland! Healthy Cleveland Insurance Guide Dial Dial Acknowledgements On behalf of the City of Cleveland Department

More information

I Have Health Insurance! Now What?

I Have Health Insurance! Now What? I Have Health Insurance! Now What? A Guide to Using Your Private Health Insurance Plan Brought to you by: Congratulations on Your New Health Plan! This guide is an overview of private insurance plans and

More information

Consumer Guide to. Health Insurance. Oregon Insurance Division

Consumer Guide to. Health Insurance. Oregon Insurance Division Consumer Guide to Health Insurance Oregon Insurance Division The Department of Consumer and Business Services, Oregon s largest business regulatory and consumer protection agency, produced this guide.

More information

Frequently Asked Questions About Your Hospital Bills

Frequently Asked Questions About Your Hospital Bills Frequently Asked Questions About Your Hospital Bills The Registration Process Why do I have to verify my address each time? Though address and telephone numbers remain constant for approximately 70% of

More information

Financial and Insurance Issues

Financial and Insurance Issues 1-Insurance Issues Financial and Insurance Issues Health insurance Programs that help patients pay for medical care. Private companies provide insurance. So, does the government. It s an unfortunate fact:

More information

Hospitals and the Affordable Care Act (ACA)

Hospitals and the Affordable Care Act (ACA) Hospitals and the Affordable Care Act (ACA) General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Corporate Account Customer Support at: 1-888-259-8414

More information

Insurance Authorization Process Inefficiencies & Opportunities

Insurance Authorization Process Inefficiencies & Opportunities Insurance Authorization Process Inefficiencies & Opportunities INTRODUCTION Medical practices, hospitals, and health systems are losing substantial money and business to inefficient and costly insurance

More information

Financial Planning. Patient Education Guide to Your Kidney/Pancreas Transplant Page 18-1. For a kidney/pancreas transplant.

Financial Planning. Patient Education Guide to Your Kidney/Pancreas Transplant Page 18-1. For a kidney/pancreas transplant. Patient Education Page 18-1 For a kidney/pancreas transplant Kidney and pancreas transplants are expensive. Planning your finances, both your income and insurance, will be a key part of planning for transplant.

More information

Medicare. Orientation Guide

Medicare. Orientation Guide Medicare Orientation Guide Your Medicare Orientation Guide At MCS Classicare (HMO), we take care of you so you feel better every day. That s why we want to get you familiar and provide you with the tools

More information

Timeline: Key Feature Implementations of the Affordable Care Act

Timeline: Key Feature Implementations of the Affordable Care Act Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next

More information

A Roadmap to Better Care and a Healthier You

A Roadmap to Better Care and a Healthier You FROM COVERAGE TO CARE A Roadmap to Better Care and a Healthier You Step 2 Understand your health coverage Your ROADMAP to health 2 Understand your health coverage Check with your insurance plan or state

More information

Medicare and Your Mental Health Benefits CENTERS FOR MEDICARE & MEDICAID SERVICES

Medicare and Your Mental Health Benefits CENTERS FOR MEDICARE & MEDICAID SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare and Your Mental Health Benefits This is the official government booklet about Medicare mental health benefits for people in the Original Medicare Plan.

More information

The Financial Obligations of Liver Transplantation

The Financial Obligations of Liver Transplantation The Financial Obligations of Liver Transplantation Planning for Financial Obligations There is a definite need to have a plan going into transplant. That need applies to the financial side of transplant,

More information

MAWD or Marketplace?

MAWD or Marketplace? MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage Summary Choosing health insurance coverage that best meets one s needs is important, especially

More information

801501-MSP-WI. Medicare Supplement

801501-MSP-WI. Medicare Supplement 801501-MSP-WI Medicare Supplement 1 Medicare supplement Not so surprisingly, seniors have questions about health care - especially Medicare. Even with all of the information out there you may still be

More information

Coverage for Addiction and Mental Illness: Now It Is the Law

Coverage for Addiction and Mental Illness: Now It Is the Law Coverage for Addiction and Mental Illness: Now It Is the Law How to be your best advocate when working with your health insurance company Hazelden s Center for Public Advocacy hazelden.org 800-257-7800

More information

The Health Care Law and

The Health Care Law and The Health Care Law and p Faith leaders are trusted partners in local communities. You have a unique ability to reach people, especially the most vulnerable, with the tools and information they need to

More information

Are You a Hospital Inpatient or Outpatient?

Are You a Hospital Inpatient or Outpatient? Are You a Hospital Inpatient or Outpatient? If You Have Medicare Ask! Revised May 2014 Did you know that even if you stay in a hospital overnight, you might still be considered an outpatient? Your hospital

More information

UAMS UnitedHealthcare Group Medicare Advantage (PPO) 2014 benefit plan Y0066_130717_100929

UAMS UnitedHealthcare Group Medicare Advantage (PPO) 2014 benefit plan Y0066_130717_100929 UAMS UnitedHealthcare Group Medicare Advantage (PPO) 2014 benefit plan Y0066_130717_100929 Welcome Why We re Here Medicare Basics Plan Benefits Questions & Answers How to Enroll Why UnitedHealthcare? UnitedHealthcare

More information

MEDICARE SUMMARY NOTICE

MEDICARE SUMMARY NOTICE How To Read Your MEDICARE SUMMARY NOTICE This booklet shows examples of what you may see on your Medicare Summary Notice (MSN) and helps you understand how to read your MSN. You receive an MSN quarterly

More information

Patient Billing & Insurance Information Q&A

Patient Billing & Insurance Information Q&A Patient Billing Requirements Patient Billing & Insurance Information Q&A At your first visit our office you are required to bring your insurance card and driver s license. Our office will copy this information

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

NH Medicaid Managed Care Supplemental Issue

NH Medicaid Managed Care Supplemental Issue Empowering and informing families and professionals caring for children with special health care needs and disabilities from birth to adulthood. NH Medicaid Managed Care Supplemental Issue In 2011 the

More information

Health Net Member Services: For help or information, please call Member Services or go to our Plan website at www.healthnet.com.

Health Net Member Services: For help or information, please call Member Services or go to our Plan website at www.healthnet.com. f Your Medicare Health Benefits and Services as a Member of Health Net Value Orange Option 2 This mailing gives you the details about your Medicare health coverage from January 1 December 31, 2009, and

More information

Outline of Coverage. Medicare Supplement

Outline of Coverage. Medicare Supplement Outline of Coverage Medicare Supplement 2015 Security Health Plan of Wisconsin, Inc. Medicare Supplement Outline of Coverage Medicare Supplement policy The Wisconsin Insurance Commissioner has set standards

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-371-9622. Important

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors

More information

ANSWERS TO MOST-ASKED QUESTIONS

ANSWERS TO MOST-ASKED QUESTIONS ANSWERS TO MOST-ASKED QUESTIONS HOW TO GET STARTED WITH YOUR HEALTH PLAN When you first enroll in a health plan with MVP Health Care, you ll receive your MVP Member ID card in the mail. This card and your

More information

This Medicare Counselor Training program was developed under a grant from UnitedHealthcare through a joint project with the National Association of

This Medicare Counselor Training program was developed under a grant from UnitedHealthcare through a joint project with the National Association of 1 This Medicare Counselor Training program was developed under a grant from UnitedHealthcare through a joint project with the National Association of Area Agencies on Aging (n4a). However, nothing in these

More information

MAJOR REVENUE-CYCLE STRESS POINTS

MAJOR REVENUE-CYCLE STRESS POINTS Healthcare Insights How Healthcare Reform Impacts Your Revenue Cycle: Scott Krah, AAP Vice President and Senior Product Manager Healthcare Payments KeyBank Enterprise Commercial Payments KEY TAKEAWAYS

More information

Medicare Supplement. CI-AML-MSPBroch-NJ R 513

Medicare Supplement. CI-AML-MSPBroch-NJ R 513 Medicare Supplement R 513 Medicare Supplement Not so surprisingly, seniors have questions about health care - especially Medicare. Even with all of the information out there you may still be wondering

More information

Women have a different relationship to the health care system than

Women have a different relationship to the health care system than CHAPTER 4: WOMEN S ACCESS TO HEALTH CARE have a different relationship to the health care system than men. are more likely to use health care services because of their health status, higher incidence of

More information

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 REFERENCE # SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 CHARITY AND UNCOMPENSATED CARE Purpose To provide definition of health care assistance to eligible

More information

EVIDENCE OF COVERAGE. A complete explanation of your plan. Health Net Green (HMO) January 1, 2010 December 31, 2010

EVIDENCE OF COVERAGE. A complete explanation of your plan. Health Net Green (HMO) January 1, 2010 December 31, 2010 EVIDENCE OF COVERAGE A complete explanation of your plan Health Net Green (HMO) January 1, 2010 December 31, 2010 Important benefit information please read H0755_2010_0389 10/2009 January 1 December 31,

More information

Outline of Coverage. Medicare Supplement

Outline of Coverage. Medicare Supplement Outline of Coverage Medicare Supplement 2016 Security Health Plan of Wisconsin, Inc. Medicare Supplement Outline of Coverage Medicare Supplement policy The Wisconsin Insurance Commissioner has set standards

More information

801501-MSP-A. Medicare Supplement

801501-MSP-A. Medicare Supplement 801501-MSP-A Medicare Supplement 1 Medicare supplement Not so surprisingly, seniors have questions about health care - especially Medicare. Even with all of the information out there you may still be wondering

More information

California Public Hospitals and the Health Care Coverage Initiatives: A Model for Health Care Reform

California Public Hospitals and the Health Care Coverage Initiatives: A Model for Health Care Reform California Association of Public Hospitals and Health Systems April 2009 POLICY BRIEF 70 WASHINGTON STREET, SUITE 215 OAKLAND, CALIFORNIA 94607 510.874.7100 WWW.CAPH.ORG California Public Hospitals and

More information

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business 2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of business Choose BETTER. 31 Important deadline Open enrollment begins on November 15, 2014 for coverage beginning

More information

Managing Care for Adults With Long-term Medical Illnesses. A Review of the Research

Managing Care for Adults With Long-term Medical Illnesses. A Review of the Research Managing Care for Adults With Long-term Medical Illnesses A Review of the Research Is This Information Right for Me? If you meet all of the following, this information is for you: You or someone you care

More information

Key Features of the Affordable Care Act, By Year

Key Features of the Affordable Care Act, By Year Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll

More information

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals

More information

Your Health Insurance: Questions and Answers

Your Health Insurance: Questions and Answers Your Health Insurance: Questions and Answers This simple guide will help you understand how to use and keep your health insurance Meet four people with questions about their health insurance: George is

More information

Evidence of Coverage

Evidence of Coverage January 1 December 31, 2016 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Kaiser Permanente Senior Advantage Medicare Medicaid (HMO SNP)

More information

Your Pharmacy Benefit: Make it Work for You!

Your Pharmacy Benefit: Make it Work for You! Your Pharmacy Benefit: Make it Work for You! www.yourpharmacybenefit.org Table of Contents Choose Your Plan.............................................2 Steps in Choosing Your Pharmacy Benefits.........................

More information

Evidence of Coverage. H8067_C_EOC_0915 CMS Accepted/File & Use 9/28/2015

Evidence of Coverage. H8067_C_EOC_0915 CMS Accepted/File & Use 9/28/2015 2016 Evidence of Coverage For more recent information or other questions, please contact Provider Partners Health Plan at 1-800-405-9681 or, for TTY users, 711, from 8 a.m. to 8 p.m. Monday through Friday,

More information

Patient Financial Policy

Patient Financial Policy Patient Financial Policy We want you to concentrate on feeling better instead of worrying about how you're going to pay your bill. Please review this Patient Financial Policy for answers to commonly asked

More information

Fact Sheet: The Affordable Care Act s New Patient s Bill of Rights

Fact Sheet: The Affordable Care Act s New Patient s Bill of Rights http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html Fact Sheet: The Affordable Care Act s New Patient s Bill of Rights June 22, 2010 A major goal of the Affordable Care Act the health

More information

What Are Ambulatory Surgery Centers?

What Are Ambulatory Surgery Centers? What Are Ambulatory Surgery Centers? Ambulatory surgery centers, or ASCs, are facilities where surgeries that do not require hospital admission are performed. ASCs provide cost-effective services and a

More information

MEDICARE: You ve earned It. Make the most of it.

MEDICARE: You ve earned It. Make the most of it. Cigna Medicare Services MEDICARE: You ve earned It. Make the most of it. A simple guide filled with useful information on Medicare, health and wellness and more. Section 1 MEDICARE. PLAIN AND SIMPLE. Section

More information

Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP

Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP January 1 December 31, 2015 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP This booklet gives you the

More information

Moda Health Coverage Outline

Moda Health Coverage Outline Moda Health Coverage Outline Thank you for your interest in the Moda Health Senior Select Medicare Supplement plan! Attached is a copy of the policy Outline of Coverage and we have supplied you with a

More information

Melanie Ehni Mouzoon, M.D., F.A.A.P Managing Physician for Immunization Practices and Travel Medicine, Kelsey-Seybold Clinic

Melanie Ehni Mouzoon, M.D., F.A.A.P Managing Physician for Immunization Practices and Travel Medicine, Kelsey-Seybold Clinic Melanie Ehni Mouzoon, M.D., F.A.A.P Managing Physician for Immunization Practices and Travel Medicine, Kelsey-Seybold Clinic 1. Be able to name at least one barrier to adult immunization related to each

More information

Evidence of Coverage:

Evidence of Coverage: January 1 December 31, 2016 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Advantra Silver (HMO) This booklet gives you the details about

More information

Comprehensive Health Insurance Billing Coding Reimbursement

Comprehensive Health Insurance Billing Coding Reimbursement Comprehensive Health Insurance Billing Coding Reimbursement SECOND EDITION CHAPTER 17 Refunds, Follow-up, and Appeals Key Terms and Abbreviations administrative law judge (ALJ) hearing documentation Employee

More information

: Western University of Health Sciences (Oregon)

: Western University of Health Sciences (Oregon) : Western University of Health Sciences (Oregon) All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest Coverage Period: March 1, 2015-February 29, 2016 Summary of Benefits

More information

MEDICARE SUPPLEMENT INSURANCE

MEDICARE SUPPLEMENT INSURANCE Illinois Insurance Facts Illinois Department of Insurance Rev Feb 2014 MEDICARE SUPPLEMENT INSURANCE What is Medicare? Medicare is a federal health insurance program for people 65 or older, some people

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Published: March 2015 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

Understanding Insurance and Our Billing Process

Understanding Insurance and Our Billing Process Understanding Insurance and Our Billing Process Thank you for choosing Cleveland Clinic for your healthcare needs. We appreciate the confidence you have placed in us. The purpose of this brochure is to

More information

Health Care in Rural America

Health Care in Rural America Health Care in Rural America Health care in rural communities has many aspects access to physicians, dentists, nurses, and mental health services; the financial circumstances of rural hospitals; federal

More information

Prescription Drug Plan (PDP)

Prescription Drug Plan (PDP) Prescription Drug Plan (PDP) Blue Shield of California Medicare Rx Plan (PDP) Evidence of Coverage Effective January 1, 2015 Blue Shield of California is a PDP with a Medicare contract. Enrollment in Blue

More information

2015 Evidence of Coverage

2015 Evidence of Coverage Molina Medicare Options Plus HMO SNP Member Services Method Member Services Contact Information CALL (800) 665-1029 Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m., local time. Member Services

More information

Helping you choose the Medicare coverage that best meets your healthcare needs.

Helping you choose the Medicare coverage that best meets your healthcare needs. Plan Selection Service Allsup Experts are Ready to Help The process of finding the Medicare plan that works best for you can be time-consuming and overwhelming without sufficient guidance. As trusted experts

More information

Medicare Mental Health Coverage

Medicare Mental Health Coverage Medicare Mental Health Coverage ISSUE BRIEF VOL. 4, NO. 3, 2003 This ongoing series provides information on how to develop programs to educate Medicare beneficiaries and their families. Additional information

More information

Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc.

Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc. Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc. Annual Notice of Changes for 2015 You are currently enrolled as a member of Piedmont WellStar Medicare Choice HMO.

More information

Answers to questions that many parents ask about how the CAH program works. Helpful advice from other parents who have children in the CAH programs

Answers to questions that many parents ask about how the CAH program works. Helpful advice from other parents who have children in the CAH programs Preface Care at Home: A Handbook for Parents is a guide that is intended to help parents/guardians meet some of the challenges of caring for a physically disabled child at home. It includes information

More information

4C s Clinic Billing and Collection Policy

4C s Clinic Billing and Collection Policy 4C s Clinic Billing and Collection Policy -Approved GB 07/28/11 -Effective 10/01/11 The 4C s Clinic expects patients to pay their outstanding balances in a timely manner. A bill for services is based on

More information

Evidence of Coverage

Evidence of Coverage January 1 December 31, 2016 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Kaiser Permanente Medicare Plus (Cost) This booklet gives you the

More information

To help stay on schedule, keep your own written record of when you get the tests and exams. Include your goals and test results.

To help stay on schedule, keep your own written record of when you get the tests and exams. Include your goals and test results. Oregon Diabetes Resource Bank Handouts to help people with diabetes 1 KNOW which tests, exams, and other care you should be getting. According to national standards for quality care for diabetes, there

More information

EXPANDING THE POSSIBILITIES. states. must close the gap: low-income women. need health insurance

EXPANDING THE POSSIBILITIES. states. must close the gap: low-income women. need health insurance EXPANDING THE POSSIBILITIES states must close the gap: low-income women need health insurance ABOUT THE CENTER The National Women s Law Center is a non-profit organization whose mission is to expand the

More information

Using Your Medicare Drug Plan: What to Do if Your Medicine Isn t Covered

Using Your Medicare Drug Plan: What to Do if Your Medicine Isn t Covered Using Your Medicare Drug Plan: What to Do if Your Medicine Isn t Covered SPRING 2009 9 www.yourpharmacybenefit.org Table of Contents How does it work?............................................ 1 When

More information

Evidence of Coverage

Evidence of Coverage January 1 December 31, 2014 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Kaiser Permanente Senior Advantage (HMO) This booklet gives you

More information

The Uninsured Population in Texas:

The Uninsured Population in Texas: REPORT The Uninsured Population in Texas: July 2014 Understanding Coverage Needs and the Potential Impact of the Affordable Care Act Prepared by: Katherine Young and Rachel Garfield Kaiser Family Foundation

More information

Are You a Hospital Inpatient or Outpatient? If You Have Medicare Ask!

Are You a Hospital Inpatient or Outpatient? If You Have Medicare Ask! CENTERS FOR MEDICARE & MEDICAID SERVICES Are You a Hospital Inpatient or Outpatient? If You Have Medicare Ask! Did you know that even if you stay in the hospital overnight, you might still be considered

More information

How Outsourcing Significantly Reduces Accounts Receivables, Improves Collections and Decreases Denied Claims...All Within 30 Days

How Outsourcing Significantly Reduces Accounts Receivables, Improves Collections and Decreases Denied Claims...All Within 30 Days How Outsourcing Significantly Reduces Accounts Receivables, Improves Collections and Decreases Denied Claims...All Within 30 Days Page 1 The fast-paced healthcare industry is becoming competitive and organizations

More information

Getting started with Medicare.

Getting started with Medicare. Getting started with Medicare. Medicare Made Clear TM Get Answers: Medicare Education Look inside to: Understand the difference between Medicare plans Compare plans and choose the right one for you See

More information

Financial Information for Kidney and/or Pancreas Transplantation

Financial Information for Kidney and/or Pancreas Transplantation Financial Information for Kidney and/or Pancreas Transplantation Transplantation is an expensive treatment for kidney and/or pancreas disease and it is important for you to plan ahead and be well informed

More information

Are there services this Yes. Some of the services this plan doesn t cover are listed on page 6. See your policy or plan

Are there services this Yes. Some of the services this plan doesn t cover are listed on page 6. See your policy or plan : SAIF Corporation All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest Coverage Period: January 1, 2016-December 31, 2016 Summary of Benefits and Coverage: What this Plan

More information

Health plans for every body

Health plans for every body Health plans for every body Supplemental coverage for Medicare members Medicare modahealth.com/medicare Available April 1 through Dec. 31, 2015 Hello. Welcome to Moda Health, the place you go when you

More information

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 Washington Medicare Supplement Enrollment Application for Plans A, F, High Deductible F and N P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 ou are eligible to apply for

More information

EVIDENCE OF COVERAGE

EVIDENCE OF COVERAGE Samaritan Advantage Health Plan (HMO) EVIDENCE OF COVERAGE Conventional Plan 2016 H3811_MM170_2016B Form CMS 10260-ANOC/EOC OMB Approval 0938-1051 (Approved 03/2014) January 1 December 31, 2016 Evidence

More information

No medical questions Affordable monthly premium Easy online enrollment

No medical questions Affordable monthly premium Easy online enrollment Limited benefit medical insurance coverage for individuals and families. No medical questions Affordable monthly premium Easy online enrollment The IHC Group is an insurance organization composed of Independence

More information

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009 The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine

More information

reinventing health insurance brings challenges for hospitals

reinventing health insurance brings challenges for hospitals reinventing health insurance brings challenges for hospitals 1 3 Introduction 4 01 / Containing costs while increasing access and quality 5 02 / Coordinating patient care 6 03 / Boosting training and development

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-322-0160. Important

More information

Understanding Healthcare Prices. A New York State Consumer Guide

Understanding Healthcare Prices. A New York State Consumer Guide Understanding Healthcare Prices A New York State Consumer Guide Contents Acknowledgments 2 Introduction 3 For Consumers with Health Insurance Coverage 5 What to Know About Emergency Care 10 In-Network

More information

Boston College Student Blue PPO Plan Coverage Period: 2015-2016

Boston College Student Blue PPO Plan Coverage Period: 2015-2016 Boston College Student Blue PPO Plan Coverage Period: 2015-2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: PPO This is only a

More information

Guide to Taking Control of Your Healthcare

Guide to Taking Control of Your Healthcare Guide to Taking Control of Your Healthcare Why Personal Health Records Empower a Healthier America Taking Control of Your Healthcare Guide to taking control of your healthcare Why Personal Health Records

More information

Understanding Insurance and Our Billing Process

Understanding Insurance and Our Billing Process Understanding Insurance and Our Billing Process Thank you for choosing Cleveland Clinic for your healthcare needs. We appreciate the confidence you have placed in us. This brochure has been prepared to

More information

Decoding the language of health-care financing: a primer

Decoding the language of health-care financing: a primer by Dimitri Drekonja, MD, MS, FACP After what seemed like a short hiatus, health-care stories are creeping back into the news, with numerous (and often contradictory) claims: The Affordable Care Act (aka

More information

Creating a 5-Star Health Insurer

Creating a 5-Star Health Insurer HEALTHCARE WHITE PAPER Consulting Creating a 5-Star Health Insurer A healthy customer experience can lead to hundreds of millions of dollars in bonus payouts for Medicare Advantage and Part D prescription

More information

Frequently Asked Billing Questions

Frequently Asked Billing Questions Frequently Asked Billing Questions How will I be billed? Mayo Clinic Health System will send you a billing statement with your charges. Provider charges for clinic and hospital services will be billed

More information

Shopping for a health care plan can be confusing. Let us help.

Shopping for a health care plan can be confusing. Let us help. We re here to help Shopping for a health care plan can be confusing. Let us help. Thank you for trusting Anthem Blue Cross and Blue Shield for your health coverage. We re here to protect you from the high

More information