UNDERSTANDING YOUR HOSPITAL BILL AND THE PAYMENT PROCESS
The hospital billing and payment process can be complex and confusing. This information will help explain our hospital’s billing and payment policies, and the resources available to help you.
Billing
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and
hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 316-425-2400
Rights & Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers
there may be out-of-network. In these cases, the most those providers may bill you is your plan’s innetwork cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance
(prior authorization). - Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact 1-800-985-3059.
Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Up-front Payment
Our hospital’s practice is to collect all known fees when you register, including deductibles, co-payments and co-insurance. If it is higher, we may ask you for additional payment upon discharge. If it is lower, we will promptly refund the difference owed to you.
Payment by insurance
If you have health insurance, we will bill your insurance carrier shortly after your visit, and your insurance carrier should pay your bill within 60 days. Your insurance company may contact you for additional information to process your claim. Please respond as quickly as possible to ensure you receive the maximum benefit from your coverage.
When will the hospital contact me?
If you pay up-front or with insurance, you will not receive further communication from the hospital unless the insurance company has not paid your claim or a balance is due from you (e.g., the portion not covered by your insurance or paid at the time of your visit).
Payment without Insurance
If you do not have insurance, you will be asked to pay in full at the time of service. If you are unable to pay, we will work with you to:
- Set-up a payment plan
- Apply for coverage through Medicaid
- Apply for the Charity Care through RRH
- Explore insurance options through the Health Insurance Marketplace*
*Only during annual enrollment
Can I get an exact pricing quote?
Unfortunately, no. We will do our best to provide you with a range of what you can be expected to pay based on our hospital’s historical pricing for similar services. Price quotes are not guaranteed since the services used to compute the quote can vary from the services you receive due to treatment decisions, unforeseen complications, additional tests or services ordered by your physician, and variation in the clinical needs of each patient. To receive a pricing estimate, or for assistance in understanding charges associated with a procedure or encounter, please contact our Financial Counselor.
Financial Counselor
Pricing Transparency
All U.S. hospitals and health systems are required to make public a list of all standard charges. When reviewing this data, it is important to remember that these are rarely the price a patient would pay. Every insurance contract and benefit plan design is different, resulting in variability to standard charges. Additional pricing transparency resources are currently being developed. If you have questions about Rock Regional Hospital’s pricing transparency efforts, please contact our Director of Business Services.
Director of Business Services
Other Charges
Your hospital bill contains charges for hospital services only. Some of the services you receive during your visit may be from providers who are affiliated with our hospital, but are not employed or operated by our hospital. Therefore, you may be billed separately for certain professional services, which may include:
- Your physician
- ER physicians
- Radiologists
- Hospitalists
- Pathologists
- Cardiologists
- Anesthesiologists
For questions about your hospital bill: 316-239-7170
You may also email us at: rrhbilling@rrhderby.com