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Provided below is a list of Frequently Asked Questions. For answers to your specific billing questions, please contact our Customer Service Representatives at the facility in which you were seen; or, call the customer service number listed on your billing statement.
A representative from our Admitting Department may provide you with an estimate of your total charges prior to your visit, during your visit, or before you are discharged from our hospital. You will be asked to pay your co-payment, deductible and/or co-insurance at that time. Dignity Health will then bill the health insurance company on your behalf. If the bill is unpaid because the insurance company states you no longer have health insurance coverage, we will send you a bill. If you have changed insurance companies, contact us as soon as possible so we may change the information on file and bill the account correctly. If your health insurance coverage is through Medi-Cal, an HMO or Worker Compensation, you may not receive a bill. If your bill is denied or your HMO determines that a portion of the bill is a patient responsibility, you will receive a bill. If your provided estimate was too high, we will send you a refund for the amount you overpaid after your claim has been reviewed and paid by your insurance company.
Doctors are not employed by the hospital. Doctors keep their own patient information because your health insurance coverage may be different for a doctor than it is for hospital services. For these reasons, doctors and the hospitals keep separate health insurance information.
For patients with health insurance: once your insurance company has been billed and has responded to us, we determine how much you may owe and bill you. Depending on how quickly the insurance company processes the bill, it may take 3 to 12 weeks for you to receive a bill. Other causes for delays in receiving your billing statement can be due to wrong address, or a recent move, therefore, it is important to contact the billing office to update us with your current address and personal information.
The amount that is due from the patient is rarely based on the total charges for the account, so the itemized bill may be of little use to you. Most insurance companies pay at a reduced rate from the total charges. The patient's amount is then based on this reduced rate. If you would like a copy of an itemized statement, please contact the Business Office at 800.644.1636.
"Adjustment" (discount) refers to the portion of your bill that your hospital or doctor has agreed not to charge. Insurance companies pay hospital charges at discounted rate. The amount of the discount is specific to each insurance company. When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-insurance). For example, a hospital may charge $10,000 for a surgery that your insurance has agreed to only pay $2,500. Of that $2,500, the patient would have to pay $500 if the patient's responsibility is 20%. After the insurance pays $2,000 and patient pays $500, the remaining $7,500 would be the adjustment.
Unfortunately, under a provision called coordination of benefits, the hospital is required to bill the insurance that would be considered primary for you. Any health insurance for which you are the primary holder must be billed before any other health insurance.
When someone comes to the Emergency Room, it is implied that they have a medical emergency. Specific Federal regulations (EMTALA) require that Emergency Room Clinicians first see the patient before we can discuss any financial questions. We understand that this restriction can be frustrating. However, the regulations are there to ensure everyone who comes to an Emergency Room will be seen regardless of their ability to pay. Once you have been medically evaluated and stabilized, you will be asked to pay your co-payment, deductible, co-insurance, or deposit by someone from our Admitting Department.
Please note that you may receive more than one bill for services received at the hospital. doctor charges, may include bills for Radiologists, Anesthesiologists, Cardiologists, and Pathologists, and will be billed separately. Doctors are independent of the hospital and bill for their services separately. In addition, they are required to bill on a different form than the hospital and sometimes even bill different offices at your insurance company. In the State of California, if you do not have insurance or have high medical costs you may also qualify for a discount on your doctor’s bill from your emergency room doctor. For more information please contact your doctor.
While each insurance company is different, we generally expect full payment from your insurance company within 45 days of billing. If your insurance company does not pay the bill within 45 days, we may send you a notification of their non-payment and request that you contact them to send the payment.
A representative from our Admitting Department may provide you with a “Patient Out of Pocket Financial Estimate”. This will be a “best estimate” based on the information regarding your procedure(s) provided by you, your doctor and/or clinical staff and the billing codes. If you are insured, it will also be based on your insurance coverage and our contract with your insurance company. Once we receive a payment or denial from your insurance company, you will receive a statement showing the amount that is due from you. This amount should be the same amount noted on the Explanation of Benefits (EOB) you receive from your insurance company. This amount is due when you receive the statement. If you have questions, please contact your insurance company or our Customer Service number located on your billing statement. Please note that if your insurance company fails to make any payment on your account, we may ask for full payment from you.
We accept cash, check, VISA, MasterCard and personal checks. If additional methods of payment are required, please contact our Customer Service number located on your billing statement, and we will work with you to facilitate timely payment.
Where can I find answers to questions about Medicare?
Go to www.medicare.gov for more information on Medicare.
What is an Advance Beneficiary Notice (ABN)?
An Advance Beneficiary Notice (ABN) is a written notice from either the physicians, providers or suppliers, before they provide a service or item to you, notifying you:
An ABN also gives you the opportunity to refuse to receive the service or item.
What if I cannot pay or I do not have Insurance?
If you need help paying your bill, you may qualify for a government-sponsored program or our Payment Assistance Program that may cover some or all of your balance. To determine if you qualify for payment assistance, please contact Mercy Medical Center or, call the customer service number listed on your billing statement.