At Merit Health Wesley, we strive to deliver quality health care and the best possible patient experience. Consistent with these goals, we take a positive and proactive approach to patient billing and collections. Our goal is to coordinate payment for services in the most efficient, timely and customer-oriented manner possible. We’ve compiled some frequently asked questions we hope will assist you in understanding these services and answer any questions you might have.
Q: How can I help expedite my registration process?
A: If your physician’s office scheduled your service at our hospital in advance, we will make every effort to ensure that you are pre-registered prior to your arrival. If your physician’s office was unable to schedule your service in advance, you can pre-register by contacting the registration department prior to your service. If you pre-register, your wait time may be reduced by 10 minutes or more. When you come to the hospital on the day of your service, please bring your insurance card, photo ID and the order from your physician. If at any point in our registration process you have not experienced our commitment to excellence, please ask to speak with a member of management.
Q: Why do I have to show my ID each time I visit the hospital?
A: Our primary concern is for your health and safety. We request your identification to ensure that we access and update the correct medical record. It’s also to protect you from fraud. Statistics released by the Federal Trade Commission indicate that more than 3.25 million Americans have had their personal information used by someone else for illegal activities. By requesting proof of identity, we are able to safeguard your personal medical and financial information.
Q: Why do I need to bring my insurance card to each visit?
A: In order to file an insurance claim on your behalf, it is necessary to make certain that we have the most current and accurate information about your insurance coverage and specific plan benefits. It is our policy to verify your insurance information prior to or during each visit so we may provide you the most accurate information.
Q: Why do I have to answer the same questions each time I am registered?
A: Many of the questions we ask are either required by your insurance company or requested to ensure we have your most accurate information on file. This information allows us to satisfy the requirements of your insurance company and to file your claim with little or no involvement on your behalf. If you have coverage with Medicare or Medicaid, the government mandates that certain questions and forms be completed at the time of each visit.
Q: Why am I asked to pay my co-payment and deductible on the day of service?
A: It is our goal to provide you with a comprehensive overview of your insurance benefits prior to receiving hospital services. Our process allows you the opportunity to understand how your health insurance benefits will be applied to the service and the opportunity to ask specific questions about your insurance benefits. We will also take this opportunity to discuss the financial options available for any amount not covered by your insurance. In keeping with the terms of your agreement with your insurance company, as well as the agreement between the insurance company and the hospital, it is our practice to request that co-payments and deductibles be paid prior to or on the day of service.
Q: How may I pay?
A: We accept payment by cash, check and most major credit cards.
Q: Do I need a referral?
A: If you have an HMO plan with which we are contracted, you may need a referral/authorization from your primary care physician based on your plan design. If we have not received a referral prior to your arrival for your scheduled service, we have a telephone available for you to call your primary care physician to obtain it. If you are unable to obtain the referral at that time, your appointment may be rescheduled.
Q: What are my responsibilities for Outpatient Testing/Surgery?
A: If your physician recommends a minor procedure, a staff member will be available to answer specific questions about the procedure scheduling process, discuss the paperwork and tests involved, and complete all pre-certification/authorization requirements that may be needed for your insurance company to pay the maximum benefits on your behalf. You may be asked for a pre-surgical deposit, the amount of which depends on your insurance coverage and deductible amount. A cost estimate which shows your financial responsibility, based on the benefit levels and coverage of your insurance plan, will be explained by a staff member.
Q: What if my child needs Outpatient Surgery?
A: A parent or legal guardian must accompany patients who are minors on the patient’s first visit. The accompanying adult is responsible for payment of the account, according to the policy outlined above.
Q: Who can I speak to if I have questions or comments?
A: Registration and Billing are committed to providing excellent customer service and require team members to pledge their commitment to this goal. If at any time you have questions or comments regarding your insurance coverage or your bill, please contact our Patient Accounts department. For your privacy, we need verbal or written authorization from you, the patient, if someone other than you is requesting information on your account.
Q: What does “Provider-Based” designation mean?
A: This is a Medicare status for hospitals and clinics that comply with specific Medicare regulations. Medicare has determined that this hospital has met these regulations and has been designated as such. This status requires that the hospital send two separate bills to Medicare, one for the facility and one for the physician. This means you may receive two billing statements and two separate Explanation of Benefits statements from your insurance company for one date of service.
Helpful definitions
Beneficiary: A person who receives benefits of any insurance plan or policy.
Claim: A request for payment for services submitted by the provider.
Coinsurance: A specified percentage of covered expenses which the insurance carrier requires the beneficiary to pay toward eligible medical bills.
Co-pay or Co-payment: A specific set dollar amount contracted between the insurance company and the beneficiary to be paid prior to any services rendered.
Covered Services: Services for which an insurance policy will pay.
Deductible: A specified dollar amount of medical expenses which the beneficiary must pay before an insurance policy will pay.
Explanation of Benefits (EOB): A statement from an insurance company showing the processing of a claim.
Medically Necessary: Treatments or services that insurance policies will pay for as defined in the contract.
Non-Covered Services: Services for which an insurance policy will not provide payment. These services are to be paid by the patient at the time of service.
Pre-Certification/Authorization: A service-specific requirement that your insurance company’s approval be obtained before a medical service is provided.
Provider: A person or organization that provides medical services.
