1. What is a deductible? Coinsurance? Co-payment?
Insurance plans generally have deductibles, co-payments, and/or coinsurances that are the responsibility of the subscriber, patient, and/or guarantor.
Deductible: A “deductible” is an annual expense that you must pay before your insurance benefit can begin. This amount can vary based on a place of service (i.e. doctor’s office vs. hospital). Supplemental Insurance Plans may cover this cost, however it is based on your selected insurance benefit package.
Coinsurance: A “Coinsurance” is the percentage of the total bill that is the patient and/or guarantor’s responsibility to pay. This amount can vary based on place of service (i.e. doctor’s office vs. hospital). Supplemental Insurance Plans may cover this cost, however it is based on your selected insurance benefit package.
Co-payment: A “Co-payment” is a set amount paid at each visit, based on your selected insurance benefit package. This is usually not applied towards your deductible.
For Example: On a $1000 bill, your deductible might be $200, so you would have to pay the first $200. This leaves a balance of $800. Of that $800, your co-insurance might be 20%, meaning that you will be responsible to pay $160. Your insurance company should pay $640. Once the insurance company has made payment, you should receive an explanation of benefits from you insurance and will receive a statement from the hospital indicating the remaining balance.
Questions related to an insurance company payment and/or denial should be made directly to your insurance company or benefits office.
2. Who is responsible for paying my bill?
The hospital will bill your insurance directly, unless specified otherwise. You are ultimately responsible to make certain that your bill is paid, either by the insurance and/or responsible party.
If a balance remains after your insurance has issued a payment or a denial, payment is due immediately upon receipt of your statement from the hospital.
3. How can I pay my bill?
There are several payment options, these included:
4. What other bills will I receive?
In addition to your bill from the hospital or hospital physicians, you may receive bills from other private physicians who took care of you. Physicians who may or may not participate in your health care needs these may include bills from:
-Primary Care Doctor
5. Did you bill my correct insurance?
Insurance related questions may be directed to the Patient Financial Services Department by calling 207-795-2237 or one of the telephone numbers listed above.
6. What is “pending” with my insurance?
You may have received a letter or questionnaire from your insurance company requesting additional information. If you do not respond to this request, the bill may ultimately become your responsibility.
Questions about your account may be directed to the Patient Financial Services Department at 207-795-2237 or one of the telephone numbers listed above.
7. What do I owe?
You should receive an account statement in the mail. Your statement will reflect any unpaid balances on your accounts.
Questions related to account statement balance can be directed to the Patient Financial Services Department at (207) 795-2237 or one of the numbers listed above.
8. Did you receive my payment?
There may be times where a statement is generated prior to your payment being posted. Any new payments on your account should reflect on your next account statement.
Questions about your account may be directed to the Patient Financial Services Department by calling (207) 795-2237.
9. What if I didn’t have my insurance information at the time of service?
You should contact the Patient Financial Services Department immediately by calling (207) 795-2237 or one of the telephone numbers listed above to assure proper billing requirements are met and to prevent pre-certification and timely filing issues with your insurance plan.
10. What are a referral and a pre-certification, and who is responsible for taking care of these?
Referral: Many insurance plans require a referral from your Primary Care Physician to a Specialist and/or the Hospital for specific services. Without a referral from your Primary Care Physicians, services are often denied for payment and the bill may ultimately be your responsibility.
Pre-certification: Many insurance plans require prior approval for services by patients, their Primary Care Physician, or ordering physician before services can be covered. Without pre-certification from the ordering physician, services are often denied for payment and the bill may ultimately be your responsibility.
Please review your health plan booklet or call your insurance company to clarify your benefits, referral and pre-certification requirements prior to receiving any services.
11. Why didn't my insurance pay?
You should have received an Explanation of Medical Benefits (EOMB) or Explanation of Payment (EOP) from your insurance company, showing how they considered your claim. This EOMB/EOP should have a contact telephone number or web site where you can reach your insurance company for questions. Please contact your insurance company or benefits office with questions about denied claims
12. I was injured at work – why am I getting a bill?
After notifying your employer of a work related injury, your employer should have filed a ‘Notice of Injury’ with the company’s workers compensation carrier. If they did not, the claim may be denied and become your responsibility.