Thank you for choosing SRMC for your health care needs. Insurance and paying for medical expenses can be overwhelming and confusing. SRMC is committed to making this experience a positive one.
We are here to provide patients with the tools and resources to understand insurance coverage and manage medical expenses in a caring, honest and confidential manner because your financial well-being is important too.
A complete understanding of your insurance coverage is essential when preparing for your next procedure or visit. This allows you to effectively manage the financial aspect of your care.
Understand your bill - Glossary
Co-insurance
The percentage set by your insurance company that you pay for services after you have paid the total annual deductible amount.
Co-pay
A co-pay is the amount specified by your insurance company to be paid for each office visit with a doctor. Some plans also have co-pays for other services such as Physical Therapy and ER Visits.
Contractual Adjustment
This is 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.
Co-pay
The co-pay is the amount specified by your insurance company to be paid for each office visit with a doctor. Some plans also have co-pays for other services such as Physical Therapy and ER visits. Your co-pay amount may be listed on your insurance card.
Contractual Adjustment
This is the discount that is given on services based on the contract SRMC has with your insurance company.
Deductible
The annual amount set by your insurance company must be paid by you before insurance pays for services, and before co-insurance applies to your services. An admissions representative will work with you to determine estimated cost, insurance coverage and provide several payment options to assist you if you have a high deductible.
Explanation of Benefits (EOB)
This is the paperwork you receive from your insurance company showing what they paid and what they have determined is your responsibility to pay, per your coverage. This amount should match the statement you receive from Sidney Regional Medical Center. Typically, a patient will receive multiple EOB’s for one service as insurance pays the facility charges (supplies, room, medications, labs, radiology tests) separately from the fees charged by the physicians or other providers.
Out of Pocket
This is the most you will pay during a policy period (typically one year) before your insurance starts to pay 100% for covered services. This amount generally consists of the full amount you have paid for deductibles, co-insurance, and co-payments. There are exceptions to what some plans apply to OOP.
Premium
This is 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 healthcare facilities that are part of a health plan’s network. This means the provider/healthcare 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 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 Coventry Health of Nebraska)
- Medica Commercial
- Medica Prime Solutions (Medicare Cost Plan)
- Medicaid - Healthy Blue
- Medicaid - Nebraska Medicaid
- Medicaid - Total Care Medicaid
- Medicaid - UHC Community Plan
- Medicare
- Medicare Advantage/Replacement (PFFS) plans
- Midlands Choice
- Multi-Plan (VERIFY with your insurance company to verify your policy processes all service through Multi-plan)
- 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 of the visit, patients should receive an explanation of benefits (EOB) from the 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 equal.
SRMC will send a statement showing the patient amount due if insurance either doesn’t pay for the service or leaves a remaining balance due as patient responsibility.
There can be many things that delay SRMC billing insurance or your insurance company processing the claim.
Multiple claims on one visit
For most payers, SRMC is required to bill professional fees and facility fees separately. A statement from SRMC is not sent to the patient until insurance pays on each one, which can cause a delay in the patient receiving the first statement from SRMC.
· Facility fees are for the service or procedure being provided.
· Professional fees are for the doctors, physician assistants, and anesthesiologists.
Multiple insurance coverage
If a patient has more than one insurance, this may also cause a delay as all claims must be processed by both the primary and secondary payer.
Other Helpful Information
Coordination of Benefits
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 ensure your insurance company pays for your services.
In order to ensure payment by the insurance company and to prevent claim denials made in error, it’s important the guarantor and/or patient contact the insurance company to update the Coordination of Benefits (COB). This update is typically required by the insurer on an annual basis. This is also important if there have been any significant changes to the guarantor’s and/or patient’s family (marriage, divorce, new child, the addition of step-children, etc.).
Refer to the back of the insurance card to find contact information for customer service and contact them to coordinate benefits.
Medicare self-administered medication list
Medicare publishes a list of drugs they considered to be “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 setting.
If a patient receives self-administered drugs not covered by Medicare Part B, the hospital will bill the patient. These drugs may be covered for anyone enrolled in a Medicare drug plan (Part D). The patient is then responsible to pay for the drug and/or submit a claim to Medicare for a refund. Most hospital pharmacies don’t participate in Part D.
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 means that the patient’s contract with the insurance company didn’t include coverage for the services. For questions regarding coverage, contact the insurance company to discuss coverage limits or to add services to the contract.
VA
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. Please notify SRMC at 308.254.7268 Option 1 Ext 1611 upon approval.
FAQ's
Q. WHEN WILL I RECEIVE MY BILL?
A. If you have insurance, and you provided our office with a current insurance card, our first step is to bill your insurance company. After the insurance company has processed 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. If you do not have insurance, you will receive a bill on the first date we send out statements, following your visit. Statements are sent out every 28 days.
Q. WHAT COULD DELAY MY BILL?
A. Insurance companies requesting additional information from SRMC or from the patient in regards to your services. Please read all communication you get from your insurance company. If you fail to meet their request for information you could get end up paying for services that your insurance company should be paying.
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. CAN I GET A DISCOUNT ON MY BILL?
A. Yes, if you do not have insurance 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 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 co-pays, deductibles, co-insurance or for a service the insurance company does not cover under your policy. You should have received an EOB(s) 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 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 self-administered medications given in an outpatient setting at the hospital. An outpatient setting at Sidney Regional Medical Center would include: 1) a visit in the ER, 2) being admitted for observation or 3) outpatient surgeries.
Q. DO YOU HAVE PAYMENT PLANS AVAILABLE?
A. Yes, we have payment plans available. You may be eligible to establish a monthly payment plan. Please call 308.254.8778 to find out what payment plans are available for your balance due.
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 do offer charity care 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, as this person is signing for services and to be responsible for any payment that is due.
Q. HOW CAN I GET ALL FAMILY VISITS ON ONE STATEMENT?
A. Contact the SRMC Patient Financial Services at 308-254- 8778, Monday – Thursday 8am-5pm and Friday, from 8am - 4pm.
Q. HOW DO I RECEIVE AN ITEMIZED STATEMENT?
A. Request here. Or call us at 308-254-8778 Monday – Thursday 8am-5pm and Friday, from 8am - 4pm.
Q. WHAT IS AN EOB (Explanation of Benefits)?
A. This is the paperwork you receive from your insurance company showing what they paid and what they have determined is your responsibility to pay, per your coverage. This amount should match the statement you receive from Sidney Regional Medical Center. Typically, a patient will receive multiple EOB’s for one service as insurance pays the facility charges (supplies, room, medications, labs, radiology tests) separately from the fees charged by the physicians or other providers.
Q. HOW ARE YOUR PRICES DETERMINED?
A. The Nebraska Hospital Association hospital guide is used to compare pricing with other facilities in Nebraska. 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. 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?
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, deductible 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.
Q. WILL SRMC PRE-AUTHORIZE SERVICES OR DO I?
A. Although there are some services that SRMC will pre-certify, it is best for the guarantor to contact their insurance for pre-certification as well.
Q. HOW DO I AVOID COLLECTION ACTIVITY?
A. Delays in full payment or failure to establish a payment plan that meets minimum guidelines for the amount due may cause this account to be referred to an external collection agency. Payment in full or payment plans must be established prior to the time of service on all non-emergent services.
Q. WHAT IS THE PHONE NUMBER OF THE COLLECTION AGENCY MY ACCOUNT WAS SENT TO?
A. SRMC uses two collection agencies. If the guarantor’s last name begins with A-M, please contact Panhandle Collections at 308-632-5210. If the guarantor’s last name begins with N-Z, please contact Credit Management Services at 308-382-3000.
Q. IF I NEED MEDICAL ATTENTION BUT CAN NOT AFFORD TO PAY FOR IT, WHAT CAN I DO?
A. No one is turned away from SRMC needing emergent/emergency care because of inability to pay. We direct patients to a Patient Account Specialist the Financial Counselors located in the Patient Financial Department who will work with you to develop a payment plan, help you apply for Medical Assistance or, if you qualify, arrange for free or reduced responsibility care.
Q. DO YOU ACCEPT MY INSURANCE?
A. We are contracted with most of the major payers in this area. However, some payers require different services be performed at their own facilities or contracted vendors. We strongly urge you to contact your insurance carrier (HMO, PPO, MCO, etc) to verify they will cover the services you need to have.
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 payment plans available. Call 308-254-8778, Monday – Thursday 8am-5pm and Friday, from 8am - 4pm.
