Frequently Asked Questions (FAQ)
Provided below is a
list of Frequently Asked Questions. For answers to your
specific billing questions, please contact our Customer Service
Representatives at the facility in which you were seen; or, call
the customer service number listed on your billing
statement.
1. Who will bill my
insurance?
CHW will first bill the health insurance company on your
behalf. If the bill is unpaid because the insurance company
states you no longer have health insurance coverage, we will send
you a bill. If you have changed insurance companies, contact us as
soon as possible so we may change the information on file and bill
the account correctly. If your health insurance coverage is through
Medi-Cal, an HMO or Worker Compensation, you may not receive a
bill. If your bill is denied or your HMO determines that a portion
of the bill is a patient responsibility, you will receive a
bill.
2. Why am I being asked for my insurance
information again? My doctor should already have
it.
Physicians are not employed by the hospital. Physicians keep their
own patient information because your health insurance coverage may
be different for a physician than it is for hospital services. For
these reasons, physicians and the hospitals keep separate health
insurance information.
3. I was in the hospital several weeks
ago, why haven't I received a
bill?
For patients with health insurance: once your insurance company has
been billed and has responded to us, we determine how much you may
owe and bill you. Depending on how quickly the insurance
company processes the bill, it may take 3 to 12 weeks for you to
receive a bill.
4. I received a billing statement, but
all it shows are total charges. Can I ask for an itemized
bill?
The amount that is due from the patient is rarely based on the
total charges for the account, so the itemized bill may be of
little use to you. Most insurance companies pay at a reduced rate
from the total charges. The patient's amount is then based on this
reduced rate. If you would like a copy of an itemized
statement, please contact the Business Office at (877)
877-8345.
5. Why did my billing statement have an
adjustment amount?
"Adjustment" (discount) refers to the portion of your bill that
your hospital or doctor has agreed not to charge. Insurance
companies pay hospital charges at discounted rate. The
amount of the discount is specific to each insurance company. When
the insurance company pays their portion, the discounted amount
(adjustment) is taken off to show the true amount due from the
patient (co-insurance). For example, a hospital may
charge $10,000 for a surgery that your insurance has agreed to only
pay $2,500. Of that $2,500, the patient would have to pay
$500 if the patient's responsibility is 20%. After the
insurance pays $2,000 and patient pays $500, the remaining $7,500
would be the adjustment.
6. I have coverage under both my
insurance and my husband's. Since the deductible is less
under his insurance, can you bill his insurance and not
mine?
Unfortunately, under a provision called coordination of benefits,
the hospital is required to bill the insurance that would be
considered primary for you. Any health insurance for which you are
the primary holder must be billed before any other health
insurance.
7. Can I find out how much my emergency
room service will cost and if my medical insurance will cover the
visit before seeing the doctor?
When someone comes to the Emergency Room, it is implied that they
have a medical emergency. Specific regulations require that
Emergency Room Clinicians first see the patient before we can
discuss any financial questions. We understand that this
restriction can be frustrating. However, the regulations are
there to ensure everyone who comes to an Emergency Room will be
seen regardless of their ability to pay.
8. After my hospital stay, I
received separate bills from the hospital and physicians. Why
did I receive so many bills?
Please note that you may receive more than one bill for services
received at the Medical Center. Physician charges, may
include bills for Radiologists, Anesthesiologists, Cardiologists,
and Pathologists, and will be billed separately. Physicians
are independent of the hospital and bill for their services
separately. In addition, they are required to bill on a
different form than the hospital and sometimes even bill different
offices at your insurance company.
9. When will my insurance company settle
my account?
While each insurance company is different, we generally expect full
payment from your insurance company within 45 days of billing. If
your insurance company does not pay the bill within 45 days, we may
send you a notification of their non-payment and request that you
contact them to send the payment.
10. How will I know how much I will need
to pay?
Once we receive a payment or denial from your insurance company,
you will receive a statement showing the amount that is due from
you. This amount should be the same amount noted on the Explanation
of Benefits (EOB) you receive from your insurance company.
This amount is due when you receive the statement. If you
have questions, please contact your insurance company or our
Customer Service number located on your billing statement. Please
note that if your insurance company fails to make any payment on
your account, we may ask for full payment from
you.
11. How may I make a
payment?
The Medical Centers accept cash, VISA, MasterCard, personal checks,
and some facilities accept Discover and American Express. If
additional methods of payment are required, please contact our
Customer Service number located on your billing statement and we
will work with you to facilitate timely
payment.
12. Where can I find answers to
questions about Medicare?
Go to
www.medicare.gov
for more information on
Medicare.
13. What is an Advance Beneficiary
Notice (ABN)?
An Advance Beneficiary Notice (ABN) is a written notice from either
the physicians, providers or suppliers, before they provide a
service or item to you, notifying you:
- That Medicare may deny payment for the
specific service or item
- The reason the physician, provider or
supplier expects Medicare to deny the payment
- That you may be personally and fully
responsible for payment if Medicare denies payment.
An ABN also gives you the opportunity to refuse to receive the
service or item.
14. What if I cannot pay or I do
not have Insurance?
If you need help paying your bill, you may qualify for a
government-sponsored program or CHW Payment Assistance Program that
may cover some or all of your balance. To determine if you
qualify for payment assistance, please contact the facility at
which you were seen; or, call the customer service number listed on
your billing statement.
15. What if I am unable to make the
full payment? Can I set up a payment
plan?
Yes. If you would like to set up a payment plan, please
contact the facility at which you were seen; or, call the customer
service number listed on your billing statement.
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