Patient Responsibility
If your insurance company requires authorization or pre-certification, please tell your physician or inform your insurance company. If authorization or pre-certification is not received and is considered necessary by your insurance company, they may deny your claim in part, or in full.
Third-party coverage information provided by the patient will be verified and pre-certification obtained when needed. Where there is no third-party coverage, the hospital will require a deposit equal to 45% of the estimated billed charges of providing services.
Financial Counselors will verify benefits and, if possible, determine whether or not deductibles have been met for Inpatient, Same Day Surgery, or Outpatient services with large dollar procedures. Prior to (or at) the time services are provided, co-payments and deductibles will be collected. If the patient is unable to pay the estimated amount due, satisfactory arrangements must be made. No deposit will be required for Medicare, Medicaid, or Tricare patients.
Insurance and Payments
An expected insurance payment to JCMH does not replace the patient’s obligation to pay an outstanding balance. JCMH expects payment directly from the patient or the responsible party in certain situations or if insurance payment is particularly slow.
Patient Accounting will bill up to two insurance companies if insurance information and assignment of benefits is given when admitted to JCMH. Inpatient benefits will be confirmed within 24 hours of admission or on the next working day in case of weekends or holidays. Any balance not paid within 30 days of billing will become the patient’s responsibility.
- HMOS/PPOSIf JCMH has a contract with your insurance company, the bill will be submitted according to contractual obligations. Any co-insurances, deductibles, or non-covered services are the patient’s responsibility and are payable within 30 days of billing.
- MedicareJCMH is a certified Medicare provider and will send your bill directly to Medicare for payment. If you have insurance secondary to Medicare, the Patient Accounting Office will submit the supplemental insurance claim. This supplemental claim can only be completed after JCMH has received the Medicare payment, and can only be submitted if all additional insurance information has been provided. While Medicare must be allowed as much time as needed to process a claim, supplemental insurances will have up to 30 days from billing before the outstanding balance is determined to be the patient’s responsibility.
- Medicaid Medicaid billings are also submitted on behalf of the patient. If it is determined the patient is not eligible or has not qualified for Medicaid, the patient will be billed for any services received while at JCMH.
- Worker’s CompensationWork-related injuries will be treated as a normal insurance claim. The employer or claims adjuster will confirm benefits within 48 hours of admission to the hospital. It is the patient’s responsibility to provide JCMH with all of the appropriate information.If the claim is disputed, JCMH will bill the patient’s health insurance company in lieu of the worker’s compensation claim. If worker’s compensation is denied and there is no insurance available, the patient will be responsible for the outstanding balance.
- Accident and InjuriesIf you receive treatment as a result of a vehicle accident or public injury, JCMH will hold you personally responsible for your hospital bill. Liens may be filed against insurances or with your attorney. Since such cases may require many months to resolve, JCMH will not wait for final decisions. Payment arrangements should be made on these accounts to prevent them from becoming past due.