Billing Basics
We understand that paying medical expenses can be overwhelming and confusing. That is why Sidney Regional Medical Center is committed to making this experience a positive one.
We are here to provide you with the information you need to understand insurance coverage and manage medical expenses. In order to prepare for your upcoming visit, it is necessary to understand your insurance coverage to fully understand the financial aspect of your care.
Glossary – Understand Your Bill
Coinsurance
The percentage set by your insurance company that you pay for services rendered beyond the annual deductible amount.
Copay
The amount specified by your insurance company to be paid for each office visit with a provider. Some plans also have copays for other services, such as Physical Therapy and Emergency Room visits. Your copay amount may be listed on your insurance card.
Contractual Adjustment
The discount that is given on services based on the contract SRMC has with your insurance company. Contractual adjustments do not apply in all cases.
Deductible
The annual amount set by your insurance company that you must pay before insurance will pay for services and before coinsurance will be applied to your services.
Explanation of Benefits (EOB)
The paperwork you will receive from your insurance company showing what they paid and what they have determined is your responsibility to pay based on your coverage. This amount should match the statement you receive from Sidney Regional Medical Center. Typically, a patient will receive multiple EOBs for one service as insurance pays the facility charges (supplies, room, medications, labs, radiology tests, etc.) separately from the fees charged by the physicians or other providers.
Out of Pocket (OOP)
This is the most you will pay during a policy period (typically one year) before your insurance will pay 100% for covered services. This amount generally consists of the full amount you have paid for deductibles, coinsurance, and copayments.
Premium
The amount you pay your insurance company to obtain coverage. It is typically paid monthly or per paycheck. If your employer provides insurance, this amount often comes directly out of your paycheck. If a premium is not paid, insurance coverage lapses and is no longer valid after the grace period.
In-Network Insurances with SRMC
In-network refers to providers or health care facilities that are part of a health plan’s network. This means the provider/health care facility has a contract with that insurance company and has negotiated rates for services and providers fees.
If SRMC is not in-network with the patient’s health plan, the patient may receive a bill for the services received. It is always best to call the insurance prior to receiving services in order to verify if SRMC and the provider are in-network. Below is a list of in-network insurance companies with SRMC:
- Aetna
- Ambetter – Nebraska Total Care (Commercial Plan)
- Blue Cross and Blue Shield (excluding Medicare Plans)
- Cigna (processing through Midlands)
- First Health (processing through Aetna)
- Medica Commercial
- Medica Prime Solutions (Medicare Cost Plan)
- Medicaid – Nebraska Medicaid
- Medicaid – Total Care Medicaid
- Medicaid – UHC Community Plan
- Medicare
- Midlands Choice
- Molina
- Multiplan (VERIFY with your insurance company to ensure your policy processes all services through Multiplan)
- RCI
- United Healthcare
- United Healthcare Medicare Advantage
- VA (Authorization is required for hospital visits prior to or within 72 hours of the visit. Contact 888.795.0773 to speak with a VA representative.)
*SRMC does not accept out-of-state Medicaid*
The Billing Process
The billing process begins the day services are received. Generally, within 4-8 weeks after the visit, patients should receive an explanation of benefits (EOB) from their insurance company. Shortly thereafter, patients will receive a statement from SRMC. Patients should compare the EOB to the “Patient Responsibility Due” portion of the SRMC account statement. The balance owed according to the EOB and the balance owed according to the SRMC statement should be the same.
SRMC will send a statement showing the patient amount due if insurance either doesn’t pay for the service or leaves a remaining balance that becomes the patient’s responsibility. Here is a step-by-step look at the billing process:
- Insurance information is gathered at the time of scheduling.
- Insurance card is scanned and verified by an Admissions representative when you arrive for your service(s).
- Pay any copay or set up a payment plan for your deductible or coinsurance at the time of service.
- Receive your service(s).
- Your provider will write a patient summary in your chart regarding your visit.
- Health Information Management staff will code your account based on the service(s) you received and on the provider’s patient summary.
- Your claim for your service(s) is sent to insurance.
- Payment or denial of claim is returned to SRMC.
- You receive your EOB from your insurance and your bill from SRMC for any remaining amount due.
*Steps 6-8 often require more time due to the potential for various factors that may cause delays in SRMC billing your insurance or your insurance company processing your claim.
For multiple claims on one visit, SRMC is required to bill professional fees and facility fees separately. Facility fees are for the service or procedure being provided, and professional fees are for the doctors, physician assistants/nurse practitioners, and anesthesiologists. Consequently, there might be a delay in receiving your statement(s) as we need to process multiple claims.
Multiple insurance coverages may cause a delay as all claims must be processed by both the primary and secondary payer before we can send out your first statement.
Coordination of Benefits (COB)
Coordination of Benefits allows plans that provide health or prescription coverage for a person with Medicare to determine payment responsibilities.
- Are there dependents on the insurance plan?
- Does the patient have multiple insurance coverages?
- Is the patient dependent on a spouse’s plan and has their own coverage?
- Are children covered by two or more plans?
If so, we need your help to make certain your insurance company pays for your services.
In order to confirm payment by the insurance company and to prevent claim denials made in error, it’s important that the guarantor and/or patient contacts the insurance company to update their COB. This update is typically required by the insurer on an annual basis in case there have been any significant changes to the guarantor and/or patient’s family (marriage, divorce, new child, the addition of stepchildren, etc.).
Refer to the back of the insurance card to find their customer service contact information, and contact them to coordinate benefits.
Medicare Self-Administered Medication List
There are certain drugs that Medicare designates as “self-administered drugs.” This does not mean that you actually took the medication on your own while you were in the hospital, but it is a medication that Medicare considers the patient could take on their own outside of a hospital outpatient setting.
If a patient received self-administered drugs not covered by Medicare Part B while they were receiving our ER or outpatient services, the patient would be responsible to pay for these drugs. These drugs may be covered for anyone enrolled in a Medicare drug plan (Part D). The patient is responsible to pay for the drug and can then submit to Medicare Part D for reimbursement. If a bill is received, follow the directions in the Medicare drug plan’s enrollment materials on submitting an out-of-network claim.
Non-covered Services
Non-covered services are services that are not covered by your insurance plan and become your responsibility to pay. For questions regarding coverage, contact your insurance company to discuss coverage limits or to find out what is and is not covered.
Veteran Affairs
VA authorization is required for hospital visits prior to or within 72 hours of the visit. Contact 888.795.0773 to speak with a VA representative. SRMC is not able to obtain authorization on the patient’s behalf. SRMC will bill your primary insurance for service until a VA authorization is approved.
FAQs
Q. WHEN WILL I RECEIVE MY BILL?
A. If you have insurance and have provided a current insurance card, our first step will be to bill your insurance company. After the insurance company has processed the claim(s), you will receive a bill with any unpaid portion that is due. This process usually takes an average of 30-60 days. If you have a secondary insurance or have multiple claims on one account, this process can take longer.
Q. WHAT COULD DELAY MY BILL ?
A. Insurance companies requesting additional information from SRMC or from the patient in regard to your services could delay your bill. Please read all the communication you receive from your insurance company. If you fail to meet their request for information, you could end up paying for services that your insurance company should be paying.
Q. CAN I GET A DISCOUNT ON MY BILL?
A. Yes, if you do not have insurance or a third-party payer or you had a service that your insurance does not cover, you could be eligible for a discount if you pay in full within 45 days from the date of service. The discount will be applied to your account upon receipt of payment in full.
Q. I HAVE INSURANCE, SO WHY DID I RECEIVE A BILL?
A. This is the amount that your insurance company left due to the guarantor. Typically, this amount is for copays, deductibles, coinsurance, or for a service the insurance company does not cover under your policy. You should have received an EOB from your insurance company that matches what SRMC has billed you.
Q. WHO SHOULD I CALL IF I BELIEVE THAT THE CHARGES ON MY BILL ARE INCORRECT?
A. If you have any concerns regarding your bill, please call our Patient Financial Specialists at 308.254.8778. We would be delighted to answer any questions you might have about your bill.
Q. I HAVE MEDICARE AND SUPPLEMENTAL INSURANCE. WHY DO I OWE A BALANCE?
A. Unfortunately, Medicare does not cover oral or what Medicare considers self-administered medications given in an outpatient setting at the hospital. An outpatient setting at Sidney Regional Medical Center would include 1) a visit to the ER, 2) being admitted for observation, or 3) outpatient surgeries.
Q. WHAT IS 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. DO YOU HAVE FINANCIAL ASSISTANCE?
A. Yes. We offer financial assistance for those who qualify. Qualification is based upon federal poverty guidelines, equity and assets of the patient, along with other criteria. Complete an application here.
Q. WHY ARE FAMILY VISITS NOT LISTED ON ONE STATEMENT UNDER ONE ACCOUNT NUMBER?
A. Statements are generated per guarantor. The guarantor is the person who signed the consent form at the time of admissions. Since this person signed for services, they are responsible for any payment that is due.
Q. HOW CAN I GET ALL FAMILY VISITS ON ONE STATEMENT?
A. We can combine visits with balance due when payment plans are established or when you request to add a new service to a payment plan. Contact SRMC Patient Financial Services at 308.254.8778 on Monday–Thursday 8am-5pm and Friday 8am – 4pm.
Q. HOW DO I RECEIVE AN ITEMIZED STATEMENT?
A. E-mail or call us.
Q. HOW ARE YOUR PRICES DETERMINED?
A. The Nebraska Hospital Association pricing guide and the Third Party Hospital Pricing Guides are used to compare pricing with other facilities in our region. Prices are also determined by reviewing what insurance companies will allow for services.
Q. HOW ARE CHARGES DETERMINED?
A. Charges are based on the type and level of service received. Physicians document details of the service provided, and charges are based on that documentation.
Q. I CAME IN FOR MY ANNUAL WELLNESS EXAM, BUT MY INSURANCE COMPANY IS NOT PAYING FOR IT BECAUSE IT WAS NOT “CODED” AS A WELLNESS EXAM. WHAT DO I DO?
A. At a wellness/annual visit, the insurance company pays for the provider to assess the patient’s health and for certain screenings for any undiagnosed issues. If the patient discusses any prior or current ailments, the visit may no longer be considered a physical. It will then be coded and billed as an office visit and any applicable co-pays, deductibles, or co-insurance will be due from the guarantor. If the patient has other ailments needing to be discussed or the patient becomes ill prior to this physical, a separate visit will be necessary. If you have further questions, please contact us at 308.254.8778.
Q. WHAT IS THE PHONE NUMBER OF THE COLLECTION AGENCY MY ACCOUNT WAS SENT TO?
A. SRMC uses two collection agencies. Patients could have accounts at one or both places: Panhandle Collections at 308-632-5210 and Credit Management Services at 308-382-3000.
Q. IF I NEED MEDICAL ATTENTION BUT CANNOT AFFORD TO PAY FOR IT, WHAT CAN I DO?
A. No one is turned away from SRMC when they are in need of emergent/emergency care because of an inability to pay. Contact our Patient Financial Services who will work with you to develop a payment plan, help you apply for financial assistance and, if you qualify, arrange for free or reduced responsibility care.
Q. ARE THERE PEOPLE WHO CAN HELP ME UNDERSTAND SOME OF THE CHARGES ON MY BILL?
A. We have a team of account specialists who are willing to help and assist you with your questions regarding insurance, billing, and available payment plans.
