Q: If my insurance has paid, why do I still have a balance?
A: Insurance does not always pay the entire claim. Certain portions of the claim are designated as the patient’s responsibility such as deductibles, co-insurance, and/or any non-covered charges. Any portion of the bill not covered by insurance will be billed to the responsible party.
Q: What if my insurance does not pay?
A: The hospital expects payment within 45 days from billing. If payment is not received, the hospital will look to the patient or responsible party for payment on the account. Please call your insurance company to expedite the payment process.
Q: Who is responsible for providing additional information to the insurance company?
A: This depends on the required information. The hospital will make every effort to provide any and all information within their ability to the carrier. Some information may be needed from the doctor and/or the patient. In these situations, it is the patient’s responsibility to ensure all information is sent to the insurance company.
Q: How long do I wait for my insurance to pay before it becomes my responsibility?
A: Although 45 days from billing is sufficient for your insurance to pay or respond, in some circumstances it may take longer. We will make every effort to bill your insurance and provide the requested information, but we do suggest that the patient take an active role in the resolution of the claim by calling his/her insurance company to ensure the claim is processed timely.
Q: Why didn’t my insurance pay?
A: There are a vast amount of reasons why insurance companies may not pay for certain services. Sometimes, the denial information provided to the hospital is limited. Therefore, we suggest that you contact the insurance company for detailed information as to why payment was not made.
Q: What is the amount shown on my statement as "insurance adjustment"?
A: These are discounts your insurance company negotiated with Tanner Health System through a contractual agreement. You have no financial responsibility for these amounts.
Q: Why did my insurance company send me a questionnaire?
A: Often, insurance companies need to gather additional information from policyholders before processing payments. Most of the time, they are reviewing the claims to see if services were related to an accident whereby there may be another insurance payer responsible for payment. Also, they may be looking for possible pre-existing conditions. It is important that you return the questionnaire as soon as possible in order for your claim to be processed accurately and timely.
Questions & Answers Relating to Pre-Authorizations
Q: How do I know if my services require prior authorization?
A: Each insurance company varies in regards to requirements for pre-authorizations. The best answer is to call your insurance company or refer to your insurance handbook for information pertaining to prior authorization. Remember, some services will not be paid unless a prior authorization is obtained.
Q: Who is responsible for obtaining pre-authorizations?
A: In most cases, it is the patients' responsibility to ensure pre-authorizations are obtained prior to receiving services. The doctor and the hospital will make every effort to obtain or help obtain pre-authorizations, but the patients should always call their insurance company to make sure requirements are met.
Questions & Answers: Miscellaneous
Q: What is the phone number for Medicare?
A: You can call 1.800.633.4227 or visit www.medicare.gov.
Q: What are self-administered drugs?
A: Any drugs that may be administered by the patient are considered self-administered and non-covered by Medicare when the services are provided in an observation, emergency, short stay surgery, or other outpatient area or status. Accordingly, payment for the outpatient self-administered drugs is required and expected from the patient. Examples would be oral medications, eye ointments, creams, insulin etc. Medications provided during an inpatient hospital stay are not considered self-administered drugs and are payable by Medicare.
Q: What is an observation bed/stay?
A: Observation is considered a hospital outpatient service. Observation services require the use of a bed and periodic monitoring to evaluate an outpatient condition or determine the need for possible inpatient admission. Observation services generally do not exceed 24 hours, yet may extend up to 48 hours. A patient’s stay is considered an outpatient observation service until the doctor determines that the patient should be admitted to the hospital as an in-patient or discharged. All rules regarding self-administered drugs pertain to observation services the same as for other outpatient areas—i.e. patient’s responsibility.
Q: What is an Advanced Beneficiary Notice (ABN) and why is it given?
A: Medicare requires certain medical necessity guidelines to be met prior to hospital performing certain outpatient diagnostic tests. Hospitals are required to have patients sign an ABN when a physician ordered test is not presented with a diagnosis that meets the Medicare medical necessity requirements. At this point, Medicare requires the patient to sign an ABN whereby the patient accepts financial responsibility for these charges if they still wish to have the test performed. Every effort is made by the hospital staff to work with your specific physician to ensure that the Medicare medical necessity requirements are met prior to performing the test.
Q: Why did I get a bill when I have Medicaid/Peachcare?
A: Most of the time, receiving a bill is due to our billing personnel not having complete or adequate information at the time of registration required to bill for your services. In other cases, it is due to the patient not being covered at the time of service. Please call us to discuss any concerns at 770.836.9598 or 770.836.9572.