All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the hospital’s billing procedures and charges.
If there is a question about your insurance coverage, a member of the Patient Access department will contact you or a member of your family while you are here. Following is some information Metroplex will need in order to be able to process your claim:
If You Have Health Insurance
We will need a copy of your identification card. Depending on the extent of your coverage and deductible requirements, you may be asked to pay a deposit. You will be asked to assign benefits from the insurance company directly to the hospital.
If You Are a Member of an HMO or PPO
Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your healthcare plan and their services may not be covered.
If You Are Covered by Medicare
We will need a copy of your Medicare card to verify eligibility and process your Medicare claim. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others. Deductibles and co-payments are the responsibility of the patient.
If You Are Covered by Medicaid
We will need a copy of your Medicaid card. Medicaid also has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary.
If You Have No Insurance
A representative of the Patient Access department will discuss financial arrangements with you.
Your Hospital Bill
Metroplex Health System is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. You should remember that your policy is a contract between you and your insurance company, and you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill.
Your hospital bill reflects all of the services you receive during your stay. Charges fall into two categories: a basic daily rate, which includes your room, meals, nursing care and housekeeping; and charges for special services, which include items your physician orders for you, such as x-rays or laboratory tests.
If you receive certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statements you receive from them.