Understanding Your Hospital Bills and Insurance Claims
Thank you for choosing Avera for your health care needs. Our mission is to make a positive impact in your life by providing quality services guided by Christian values.
We understand that hospital bills and health insurance claims can be confusing. We want to help you:
- Understand how we bill patients
- Receive information on financial assistance if you are unable to pay
We hope this brochure answers any questions you have. Staff in our billing offices also is available to assist you. You may reach us Monday through Friday during normal business hours. Contact us at the phone number provided on your bill.
What we need in order to serve you
Avera asks that you give us your complete health insurance information when you register. This includes:
- A driver's license or photo ID
- All insurance cards and authorization forms
We will inform you about how we use your health information to submit your insurance claim. (In Minnesota, we will ask your permission to release your health information to your insurance company.) If you have been at an Avera facility before, please give us the name of the facility and approximate date of your last visit.
Please know the benefits and requirements of your insurance coverage.
As required by your insurance company:
- Obtain proper authorizations.
- Submit referral or claims forms.
- Complete a coordination of benefits when needed.
Please respond promptly to requests you receive from your insurance company. We try to provide all information and paperwork to your insurance company. However, sometimes an insurance company needs a response from you to resolve issues related to your account or coverage. The balance owed will become your responsibility if your insurance company:
- Does not make payment within a reasonable period of time (usually 60 days after billing)
- Does not respond to our attempts to resolve payment matters on your behalf
Please call us if you have any questions about a bill. The best number to call is the number on your bill. Your physician may order tests or procedures that your insurance company does not cover. In these cases, check your health plan handbook or call the telephone number on your insurance card for more information.
Please make timely payments on your portion of the bill. Payment for your hospital bill is ultimately your responsibility. (Exceptions: approved Medicare, Medicaid, TRICARE and HMO services) At the time of service or discharge, you may be asked to pay deductibles, co-payments or other self-pay amounts due. You may be asked to pay if you do not have insurance coverage for your hospital services. For your convenience, Avera accepts cash, personal checks, debit cards, money orders and certain credit cards. Interest-free extended payment options are available to those who qualify.
Please let us know if you think you may have problems paying your part of your bill. Avera is a faith-based organization. It is our mission to assist those in need. Please let us know if you are having financial problems. Business office or billing staff can discuss payment options that may be available to you. These include:
- Extended payments
- Government programs
- Charity care/patient assistance considerations
We require certain verified personal and financial information when you apply for any of these programs.
What we will do for you
Avera will bill your insurance company on your behalf for payment of hospital services. This includes Medicare and Medicaid. Avera will bill additional insurance payors if you have more than one. In order for us to do this, you must provide coverage information to the business office.
You will receive regular, easy-to-read statements. These statements show the most current balance owed by your insurance company or due from you. After your insurance pays, Avera will send you a statement to notify you of your balance owed.
You will have access to business office or billing staff who can answer your questions.
We will help you with payment issues and questions about:
- Insurance benefits
- Hospital charges
- Payment options
- Application for financial assistance programs
We will find help with translation if needed.
Avera will treat you with dignity and respect, regardless of your ability to pay.
Your Hospital Bill
Your bill shows the charges for all of the services you receive during your stay. Charges fall into two categories. The first category is a basic daily rate. This includes your room, meals, nursing care and housekeeping. The second category is charges for special services. These include items or tests that your physician orders for you such as X-rays or laboratory tests.
Your Separate Physician Bill
You may receive bills from physicians or specialists who diagnose and interpret tests and treatments you receive while in the hospital. Often you do not see these specialists in person. They include pathologists, radiologists, anesthesiologists and others. If you have questions about these bills, please call the number printed on the statement you receive from them.
Charity and Patient Assistance Programs
Our mission is to care for all patients regardless of ability to pay. No one should put off needed medical care because of a lack of health insurance or concern about paying. That is why Avera has Charity Care and Patient Assistance Programs. These programs provide free or discounted services to patients who qualify.
If you cannot pay your part of the bill in full, the business office staff will work with you. We will help you develop a payment plan for your particular situation. If you do not have insurance or money to pay your bill, there are options for you. You may qualify for one of the government programs that will pay for your services. Avera will help you by understanding your situation. We will assist you in applying for aid.
View and/or print a copy of Avera's Financial Assistance Application »
If you do not qualify for these programs, we may still be able to help you with your bill. Avera's Charity Care and Patient Assistance Programs help uninsured or underinsured persons accepted for care with no obligation or a discounted obligation to pay for services based on income and family size. These programs are available once all other third-party resources (including local assistance programs) are exhausted.
To help determine if you qualify for Avera's Charity Care and Patient Assistance Programs, Avera:
- Uses income guidelines issued by the United States Department of Health and Human Services
- Considers all of your financial assets and liabilities
- Requires you provide the personal and financial information we ask for
You will continue to receive a bill until we decide if you qualify for the program.
We are committed to helping you and your family receive the medical care you need regardless of your financial situation. We cannot help without hearing from you. If you need special assistance, please let us know so we can find a solution for you.
Frequently Asked Questions About Billing and Insurance
Q: How do I know if my Avera facility contracts with my insurance company?
A: To receive full insurance benefits, some health plans require you to go to an "in-network" or "participating provider" doctor or hospital. Please call your insurance company to make sure of its conditions. Be sure your Avera hospital or doctor is in its network.
Q: If my Avera facility is "out-of-network," can I still go there?
A: In an emergency situation, go to the nearest hospital. Your insurance company may either cover these costs or ask that you go to an "in-network" hospital if it is safe to do so. If you choose to go to an "out-of-network" hospital in a non-emergency, you may have to pay a larger deductible or a greater part of your bill. Be sure to know the "out-of-network" rules of your insurance plan.
Q: How do I know if my insurance company will cover my hospital bill?
A: Coverage varies with each insurance company. Some insurance plans require you to call for approval before you receive certain services, or to tell the plan within a certain time after you are hospitalized. Be sure you know your insurance company's coverage requirements. On elective procedures, always ask both your physician's office and your insurance plan about coverage. Please discuss your concerns about insurance or payment with the admissions staff when you register, or with business office or billing staff as soon as possible.
Q: How will I know how much I owe?
A: Your insurance company will send you an "explanation of benefits" that shows:
- Information about what is paid
- Any non-covered, deductible or denied amounts
- The balance owed by you
Look over this notice carefully. Call your insurance company or the number on your hospital bill as soon as possible with concerns. The hospital will also send you a bill for any remaining balance due (non-covered charges and co-payments, co-insurance or deductibles you did not pay at registration or discharge from the hospital).
Q: How much will Medicare or Medicaid pay?
A: Medicare and Medicaid generally will pay for a majority of hospital services. You will be responsible for deductibles and co-payment. If you belong to a Medicare or Medicaid managed care plan, you may need an authorization to see a physician or receive hospital services.
Q: Why do I have to give you information about other insurance if I have Medicare?
A: Before we bill Medicare, Medicare requires us to bill any insurance that could be responsible for your expenses. Medicare does not allow us to file claims until the other insurance company denies them. In some cases, another party may be responsible for your expenses before we bill Medicare. For example, if you were hurt in a car accident, at work or on someone else's property, the hospital must make sure those claims are filed correctly. This is why we need to have complete information about all of your insurance.
In a spirit of charity and justice, Avera exists in response to God's calling for a healing ministry to the sick, the elderly and the oppressed, and to provide health care services to all persons in need without regard to race, sex, creed, national origin or ability to pay.
Our philosophy on providing health care:
- We believe providing health care for those who require it is an obligation of justice, as well as charity and mercy.
- We believe all persons have a right to medically necessary health care and equal access to diagnostic and therapeutic treatment regardless of ability to pay.
- We believe providing and ensuring equal access to medically necessary health care is a societal obligation and should be shared by all health care institutions and society in general.
- We believe our health care facilities, because of our deep concern for human dignity, have an obligation to respond as fully as possible to the health care needs of all people regardless of ability to pay.
- We believe we have a dual responsibility to maintain a leading role in providing medically necessary, cost-effective health care for all people and to take an advocacy role by working toward adequate reimbursement of health care services for those who do not have the ability to pay.