Request an Itemized Statment, by selecting the following link. Please include patient name, account number, and date of visit. A staff member will contact you shortly. Request an Itemized Statement
Billing, Insurance, Financial Assistance
In the Patient Financial Services department, we understand how confusing and frustrating medical billing can be. Please be assured we are here to help answer your questions and resolve any issues that you may have during this process. Feel free to contact us for questions relating to either the clinic or hospital at 308.254.8778.
The billing process begins the day you receive services. Each time you register it is important that you tell us if you carry healthcare insurance and provide us with updated insurance cards. Accurate insurance will expedite the filing of your claims with your insurance company for payment.
Any co-pays, estimated deductible amount, or co-insurance due will be collected at each visit. For non-clinic visits, payment plans are available. Within 12 weeks of your visit, you should receive an explanation of benefits (EOB) or remittance advice (RAs) from your insurance company. Shortly thereafter, you will be receiving your first statement. Please compare the EOB or RA you receive from your insurance company to the “Patent Responsibility” portion of the statement sent to you. The balance you owe according to your EOB or RA and the balance you owe according to your Sidney Regional Medical Center should equal. If they are different, for the hospital please contact Patient Financial Services for assistance regarding questions at 308.254.5825. Most insurance carriers require that professional fees be billed separately from facility charges.
Private pay patients
Patients that are not covered by insurance are known as “True Private Pay” patients. Statements for services at Sidney Regional Medical Center will be received approximately 30–45 days from your date of service. Balances are paid in full within 45 days of receiving your services, you may be eligible for a “True Private Pay” discount.
Charity Care Plain Language Summary
SRMC is committed to the provision of healthcare services to all persons in need of medical attention regardless of ability to pay. It is the policy of SRMC to treat all patients/guarantors equally, fairly and consistently. Patients seeking financial assistance can apply for charity care. You may be eligible if you are not insured, underinsured, or not eligible for sufficient coverage under any government program. Charity Care is generally secondary to all other financial resources available to the patient.
Patients may be considered for charity care for medically necessary service, on accounts with the current patient due balances and accounts with service dates within 6 months following the application approval date. When in question, Medically necessary services shall be determined by the examining physician.
Patients must be residents of Cheyenne or Deuel County and/or a 20-mile radius of Sidney. The charity will be based on household income and size, real estate, personal property, and investment equity, with credit to be given for already existing medical loans, in comparison to the current year Federal Poverty Guidelines. The HHS poverty guidelines are published each year in the Federal Register. Free care will be given to a household that is at 100% of the poverty level. Discounted care will be given at up to 300% of the poverty level. Those that are eligible shall not be charged more than the amount generally billed for emergency and medically necessary care.
How to Apply
Apply by completing an application over the phone, in person, online or via a mailed application.
Sidney Regional Medical Center
1000 Pole Creek Crossing
Sidney NE 69162
Applications are physically available at the SRMC’s Admission and Patient Financial Services departments and can be requested via mail by sending a written request to the above address. The Patient Financial Services department can provide assistance with the application processes by being contacted at the above physical address or phone number.
If there is knowledge, evidence or questionable information within the application process, supporting documentation will be required before eligibility is determined. Supporting documentation may be requested on charity greater than $5000. Supporting documentation include current year W-2’s, tax return, vehicle registration, property tax evaluations, bank statements, unemployment statement and may include a Medicaid denial letter.
SRMC is not required to have this application available in additional languages due to the demographics of our population. However, if you need help we do have a language translation line available to help us in assisting you.
Collaboration with the Finance Committee of the Board of Directors, 2009
IRS Code Section 501; Medicare Fairbilling & Collections Act
Affordable Care Act Provisions, 501(r) of the Internal Revenue Code, 2015
Patient billing FAQs
Q: How can I make a payment?
A: We accept the following forms of payment: Cash, Check, Credit Card/Debit (MasterCard, Visa, American Express, Discover), Money Orders and cashier checks:
Option 1 Pay Online: To pay your bill online by credit/debit card, by the new “Pay Online” tab on the website, www.SidneyRMC.com
Option 2 Mail Payment:
SRMC (hospital) 1000 Pole Creek Crossing, Sidney, NE 69162-1714.
Option 3 Pay in Person: Patient Financial Services, 1000 Pole Creek Crossing, Sidney, NE 69162-1714
Q: Do you have any kind of financial assistance?
A: Yes, we offer payment plans, as well as a loan program in conjunction with local banks.
We also have a Financial Adjustment Benefit Program that could reduce or eliminate your bill. This program is based on federal poverty guidelines. After completing an application, patients who qualify will have a percentage or even their entire bill forgiven. This program is based on a patient’s annual income.
Q: Can I make payment arrangements?
A: Yes, please contact the SRMC Patient Financial Services to discuss payment arrangements.
Q: What’s the minimum payment I can make?
A: The minimum payment will be different for each account and is based upon the total amount of your outstanding balance.
Q: Why do I need to establish an official payment plan?
A: By agreeing to an interest-free, no fee, no penalty payment plan, we keep your account internally and keep it from aging out to an outside source, who would charge interest. If you are unable to pay your balance, SRMC has payment options available.
Q: I don’t have insurance, can I get a discount on my bill?
A: If you are able to pay your entire balance within 45 days of receiving your first statement, you may be eligible to receive a discount. The discount will be applied upon receipt of payment in full.
Q: What is the phone number for the collection agency my account was sent to?
A: Sidney Regional Medical Center (hospital) uses Credit Management Services at 308.382.3000, SRMC Physicians Clinic uses Panhandle Collections at 308.632.5210.
What are advanced directives?
Advanced Directives are documents in which you state your choices about medical treatment or name someone to make decisions or choices about your medical treatment if you are unable to make them for yourself. They are called “Advance” Directives because they are signed in advance to let your doctor and other healthcare providers know your wishes concerning your medical treatment. Nebraska recognizes two forms of Advanced Directives a living will and Power Attorney for Health Care.
Do I have to have an advanced directive?
It is entirely your wish whether you prepare an Advanced Directive. Keep in mind that if you choose not to complete an Advanced Directive there is a greater chance that you will receive more procedures and/or treatments that you may want.
Power of Attorney
What is a power of attorney for health care?
A Power Attorney for Health Care is a legal document which allows you to appoint another person (attorney in fact or agent) to make medical decisions for you if you become temporarily or permanently unable to make decisions for yourself.
Who can be an attorney in fact?
You can select any adult such as your spouse, child, sister, brother, or close friend to be your attorney in fact. This person should be knowledgeable about your wishes, values, religious beliefs and someone you can trust. You may also appoint more than one individual to be your attorney in fact.
When does a power of attorney for healthcare take effect?
The Power Attorney for Healthcare becomes effective when you are temporarily or permanently unable to make your own health care decisions for yourself. It is important to remember that as long as you are able to make your decisions your healthcare providers will rely on you for those decisions.
What is a living will?
A Living Will is a document which tells your doctor and other healthcare providers whether or not you want life-sustaining treatments or procedures administered if you are in a persistent vegetative state or have a terminal condition. It is called “living” because
What is the 'Five Wishes'?
The Five Wishes lets your family and doctors know:
- Who you want to make health care decisions for you when you can't make them
- The kind of medical treatment you want or don't want
- How comfortable you want to be
- How you want people to treat you
- What you want your loved ones to know
Five Wishes is changing the way America talks about and plans for care at the end of life. For more information please contact Annette Krueger at 308.254.5825 or email email@example.com