Billing Frequently Asked Questions
MercyOne is proud of our commitment to living out the healing ministry of the Judeo-Christian tradition by providing exceptional and compassionate health care services that promote the dignity and well-being of the people we serve. That means providing care to persons in need, regardless of their ability to pay. We also recognize our responsibility to all patients and payers to attempt to obtain payment from those able to pay.
In this spirit, we have taken steps to ensure price transparency by providing the hospital’s standard charges for items and services. The following information is available to you:
- MercyOne participates with the Iowa Hospital Association and the www.iowahospitalcharges.com website so you can compare charges among local hospitals.
- This comparison tool provides standard charge information related to inpatient care and outpatient services.
- This tool provides basic information on hospital charges, but patients should also check with their physician or specialists’ billing office as Iowa Hospital Charges Compare only posts information related to hospital charges.
- It is important to note, a hospital “charge” is not the same as “expected payment”. “Charge” is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Because each person’s case is different based on that patient’s medical condition, a given patient’s charge will not necessarily be the same as the average or median charge. Furthermore, the actual amount paid by a patient will depend on that patient’s insurance coverage.
- You can also visit www.aha.org to access the Healthcare Financial Management Association’s Understanding Healthcare Prices: A Consumer’s Guide as well as other helpful information and videos.
- MercyOne provides financial assistance to those who qualify. Click here to access out Community Care page. Click here to download the application.
Billing Frequently Asked Questions
It depends on your insurance policy. It is your responsibility to check with your insurance company or your employer about whether or not you need prior approval or authorization before receiving services or as soon as possible in emergency situations.
Yes. The information on your insurance card is needed for MercyOne to file a claim with your insurance company. When you register, we will ask you for information about your insurance coverage and have you sign forms for consent for treatment and assignment of benefits. This registration process goes much faster when you bring your insurance information with you.
Insurance policies vary. Contact your insurance company or your employer with your specific questions about what is or is not covered by your insurance plan or if a referral is required.
Medicare does not cover some services. For example:
- self administered drugs for outpatient, observation, and ambulatory services
- inpatient or outpatient dental services in most cases outpatient laboratory screening, etc...
Please refer to your Medicare handbook to check on services you will be receiving.
You are financially responsible for your bill at the time you receive services. All account balances are due upon receipt of the bill, which indicates that the balance is now due from you. Many insurance benefits include copayments, deductibles, and coinsurance, which are the responsibility of the patient. Please be prepared to pay your portion, estimated or actual, at the time you receive services. Registration representatives can provide assistance to estimate total charges. A Financial Counselor is available at the time of registration to explain payment methods and plans.
Yes. As a service to you, MercyOne will bill your insurance company based on the information supplied by you at the time of registration. It is your responsibility to follow up on the status of your claims.
In most cases your summary statement from MercyOne New Hampton is sent to your home 14 to 21 days after you receive services. Your insurance company is billed at this time. If you do not have insurance coverage, payment can be made by cash, check, MasterCard, VISA, or Discover.
Yes, in addition to your bill from MercyOne, you may receive bills for the same date of service from other medical professional groups. Such as: physicians, radiologists, anesthesiologists and pathologists. They will bill you separately for the services they provide.
Most insurance companies will send an explanation of benefits to its subscriber. In addition, MercyOne will send you a statement indicating any payments received and the amount you are required to pay.
The account balance is due upon receipt of your bill. If you cannot pay the balance within 30 days, please contact our Patient Accounts department at MercyOne - North Iowa, 1-866-494-3001 to discuss your account. Financial assistance is available for qualified persons.
Consistent with its core values, MercyOne is committed to making quality care affordable to those with limited financial means. To determine if you are eligible for financial assistance, or for help in establishing a payment plan, contact your regional hospital business office.
“Hospital outpatient” billing refers to the billing process used for services provided in a hospital outpatient clinic. This is the national model of practice for large, integrated health care systems (such as MercyOne Des Moines Medical Center) where the hospital owns or leases space and employs support personnel involved in patient care.
How does this affect my billing?
Under this model, the care you receive will result in two separate bills. You will receive one bill from MercyOne Des Moines Medical Center for the facility charge as well as a bill from the provider group (such as the Medical Group or Iowa Heart Center) for the professional services or physician charge from the physician who provides your treatment.
Why this billing process?
Inpatients traditionally receive a facility fee and a professional service or physician charge on their hospital bill. Following this same type of billing in the outpatient setting ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as hospital departments but are not located inside of the hospital.
Does this mean patients will pay more for services?
Many insurance plans pay for health care services provided in an outpatient hospital clinic differently than those provided in a doctor’s office. Your insurance plan may require you to meet your annual deductible before it pays for health care services you receive in an outpatient hospital clinic. Your insurance company may also require you to pay a percentage of the bill, called co-insurance, rather than just an office co-payment. We recommend that you review your insurance benefits or contact your insurance provider to determine your coverage and identify any out-of-pocket expenses you may incur.
In Summary
Receiving care at a hospital outpatient department will result in two separate bills. You will receive one bill from MercyOne containing the facility charge and a separate bill from the provider who provides your treatment containing the professional or physician charge.
Depending on your insurance coverage, your insurance provider may treat these hospital outpatient charges differently than those provided in a doctor’s office. We recommend you review your insurance benefits or contact your insurance provider to determine your coverage and identify any out-of-pocket expenses you may incur.
HOSPITAL OUTPATIENT BILLING LOCATIONS:
