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North Central Heart

A Division of
Avera Heart Hospital

4520 West 69th Street
Sioux Falls, SD 57108
605-977-5000

Insurance and Billing

We will prepare and submit your insurance claims for you. In the event of overpayment, we will make the refund to you or your insurance company. If your insurance carrier requires preauthorization and/or a second opinion, please tell our billing department before elective procedures are performed. Many carriers specify individual reimbursement rates for procedures performed at different hospitals. If your insurance policy restricts which physicians you can see, please visit with our support staff.

Statement Information

In our attempt to keep you informed of the billing of your medical services, North Central Heart will send you regular monthly statements until the account balance is zero. On our statement, please note the asterisk (*) in the far right-hand margin indicating insurance or Medicare has been billed. Although all payments will be reflected on the statement, the source of the payment is not identified on the statement.

If you have been a patient at the Avera Heart Hospital of South Dakota, you will receive a statement from both North Central Heart and the Avera Heart Hospital of South Dakota.

Medicare

We accept assignment on Medicare claims. We will complete and file your Medicare claim. The Medicare payment will come to North Central Heart Institute. You will receive an explanation of benefits from Medicare stating what has been paid. Medicare will pay 80% of the North Central Heart charges after the deductible has been met. The remaining 20% is either the Medicare supplement or patient's responsibility.

Payment

Processing of your medical claim with Medicare/insurance should be complete within 60 days. Any unpaid balance deemed patient responsibility must then be paid by you within 30 days. Co-payments must be paid at the time of service.

Medicaid

Medical Assistance Programs, often referred to as Medicaid, may be administered by your state or county. If you qualify for these programs it is your responsibility to let our business office know immediately. Evidence of eligibility must be provided on the day of your visit. Medicaid claims must be processed within four months from the date of service. Without this information from you, we are unable to process your claim and will bill you personally.

Our physicians and staff look forward to working with you and want to thank you for choosing North Central Heart.