Billing, Insurance & Financial Assistance
Hospital bills and health insurance claims can be confusing. We want to help you understand how we bill patients, and get information on financial assistance.
Fully Understand Your Insurance Benefits
- To receive full insurance benefits, some health plans require you to go to an "in-network" or "participating provider" doctor or hospital. Call your insurance company to make sure of its conditions. Ask if Spencer Hospital is in your insurance plan’s network.
- In an emergency, 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.
- 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.
- Obtain any required prior authorizations, submit referral or claims forms, and complete a coordination of benefits when needed. We will assist with pre-authorization for procedures, tests, etc., however it is the patient’s responsibility to make sure that insurance has approved the procedure.
- Be informed regarding how much of your current calendar year deductible you have already paid. This will assist you in knowing what to anticipate for your remaining financial obligations.
Spencer Hospital accepts assignment on Medicare claims. We will complete and file your Medicare claims for you. You will receive an explanation of benefits from Medicare stating what has been paid. Remaining amounts will either be paid by your Medicare supplement, or become your responsibility. At the time of registration, inform Spencer Hospital staff of any Medicare supplement policies that you have, or other coverage.
Spencer Hospital has adopted policies and procedures to align with Medicare's regulations on hospitalization. This means that upon admission or in the event of extended hospital stays, patients may be issued a denial of coverage if their condition does not meet Medicare approved criteria for hospitalization. It this occurs, hospital staff will work with patients and families to find other resources to provide the appropriate level of care.
Spencer Hospital offers SHIIP (Senior Health Insurance Information Program) counseling for anyone considering a new Medicare plan or change in an existing plan. For information about SHIIP Counseling, please follow the link - Senior Health Insurance Information Program (SHIIP) or please call (712) 264-6198 to schedule an appointment with a SHIIP Counselor.
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.
When You Register at Your Clinic or Hospital
Give complete information when you register at your hospital or clinic, including driver’s license and photo ID, all insurance cards and authorization forms.
At registration, you will be informed about how we use your health information to submit your insurance claim.
After You Receive Services
Spencer Hospital will bill your insurance company, Medicare or Medicaid on your behalf for payment of medical services. The hospital will also bill additional insurance payors if you have more than one.
Medicare or your insurance company will send you an "explanation of benefits" that shows information about what is paid, any non-covered, deductible or denied amounts and the balance owed by you.
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, Spencer Hospital will send you a statement to notify you of your balance owed.
Respond promptly to requests you receive from your insurance company. 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
Your Hospital Bill
Your bill shows the charges for all of the services you receive during your stay. Charges fall into two categories:
- Basic daily rate. This includes your room, meals, nursing care and housekeeping.
- Charges for special services. These include items or tests that your physician orders for you such as X-rays or laboratory tests.
Your Clinic Bill
Your bill will show the charges for all services that you received during your visit to Milford Family Care or Sioux Rapids Family Care. If you have questions concerning your clinic bill you can contact Clinic Billing at (712) 264-8300 extension 6123.
Provider Based Billing
What is a provider-based clinic?
“Provider-Based” refers to services provided in an outpatient clinic that is considered a department of a hospital, as services are clinically integrated into a hospital. The clinical integration provides opportunities for enhanced coordination of patient care.
What is provider-based billing?
“Provider-Based” status is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that Medicare, and other qualifying insurance types, be billed in two parts – one bill for the physician’s service, and another bill for the hospital/facility resources and services. This means that you may receive a bill from the clinic and a separate bill from the hospital.
Your bill depends on your specific insurance coverage. Some patients may have to pay a higher cost because of the required separate billing for physician services and for facility and resources. The increase in cost is a result of the health plan’s coinsurance and deductible. Depending on the services being provided, patients may incur additional out-of-pocket costs, especially when a deductible has not been met. However, patients with supplement insurance coverage may not incur any additional costs.
Will my appointment be different?
Your clinical care will not change. You will continue to see your regular doctor and health care team, and continue to receive excellent-quality care. Scheduling appointments and tests will be handled as they have been in the past. At every visit, Medicare patients will be asked to complete “Medicare Secondary Payer” questionnaire containing 10 to 15 questions. While this may seem repetitive, it helps your healthcare team make sure your care is being billed in accordance with federal regulations.
Are all patients being billed this way?
No. The requirement for breaking out charges for each office visit was set by the Centers of Medicare and Medicaid. Thus, patients with Medicare, Medicare Advantage and Tricare insurance are billed using provider-based billing. At this time, commercial insurance companies do not require this breakout.
Which local clinics are considered provider-based clinics?
Currently, both Avera Medical Group Spencer and Northwest Iowa Bone, Joint & Sports Surgeons are provider-based clinics, as departments of Spencer Hospital. For more information on your provider-based bill, please contact Spencer Hospital’s Patient Accounts department at (712) 264-6124.
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, call the number printed on the statement you receive from them.
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. Spencer Hospital accepts cash, personal checks, debit cards, money orders, and certain credit cards. Interest-free extended payment options are available to those who qualify.
Quick Payment Discount
Spencer Hospital offers a “Quick Payment” discount for services provided at the hospital. When you have out-of-pocket expenses (the costs your insurance does not cover) you may be eligible for a discount if paid within two weeks of when your first bill was issued. To determine your discount, you can contact the Spencer Hospital cashier at (712) 264-8300, extension 6124 on weekdays, 8 AM – 4:30 PM. You can make this transaction in person or call the cashier to complete over the phone.
Patient Loan Program
Choose a monthly payment that best fits your budget when you enroll in the Patient Loan Program offered in conjunction with Farmers Bank of Spencer. No credit check is required and monthly payment plans can be arranged between 12-60 months. Furthermore, the payments you make through the program reflect positively on your credit rating, even if you have no credit history or have had past credit challenges. Contact a Spencer Hospital financial counselor for more information at (712) 264-8300 extension 6128 or extension 6259.
Patient Assistance Program
Depending on your current income level, you may qualify for additional payment assistance. A Spencer Hospital financial counselor can assist you with your application.
The best number to call for questions 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.
Our business office or billing staff can help you with payment issues and questions about:
- Hospital charges
- Payment options
- Application for financial assistance programs
- Language translation if needed
Spencer Hospital’s billing and business office staff can answer many of your questions. The hospital also has financial counseling services available. If you need help understanding your medical bills, please call the number on your statement or contact us by phone at (712) 264-8300 and use extension 6259 or 6128, or via email at firstname.lastname@example.org.