Q: Why didn’t my insurance company pay this?
A: Have you met your deductible or does your policy require co-pays? Most insurance policies have deductibles and co-pays.
A deductible is a certain amount of money you must pay before the insurance company starts to pay. For example, if you go to the emergency room for a broken leg and you have not been to the hospital under your current insurance plan, you must pay until you reach your deductible. Once you have paid that amount, your subsequent visits to the Hospital should be covered according to your policy.
Often insurance companies require you pay a portion of every medical bill, a co-pay. For example, they may pay for 80% of the costs and you are required to pay the other 20%. Or you may need to pay a flat $25.00 fee every time you visit your primary care provider.
Was the service covered by your insurance policy? Be sure you read and understand your policy. Be sure you know what services are covered prior to going to the doctor or hospital. Your insurance agent or insurance company can help you if you have specific questions on your policy.
Q: Why wasn’t my visit to the Emergency Room covered?
A: Every insurance policy is different, but typically companies won’t pay if they determine the visit was not an emergency. Trips to the emergency room cost more money, given the high costs of making available a highly trained emergency staff and emergency equipment 24-hours a day. If you have any doubts about whether your condition is an emergency, call your primary care provider’s office and talk to a physician or physician assistant about your condition. If the offices are closed, we recommend you call your insurance company for specifics about your policy. Lastly, if these options are unavailable, it is better to err on the safe side when it comes to your health–the cost may be well worth it.
Q: I only came to the ER, and now I’m receiving a bill from a doctor with Coastal Radiology
A: If you had x-rays, you will be receiving a bill from a radiologist. The radiologist is the doctor who reads your x-ray. MDI Hospital has the great benefit of having Dr. John Benson’s services as a highly skilled, certified, diagnostic radiologist.
Q: I have not been at MDI Hospital, why am I receiving a bill?
A: If you recently visited one of our health centers and had lab work done–if your blood was drawn, for example, the hospital does most laboratory work and bills for that processing.
Q: If I have recently switched insurance companies, but my old one is still covering me, which insurance do I use?
A: In most cases you should use your primary insurance first, which means the insurance you had previously. You should also report both insurances and make it clear which is your primary. Often, if insurance companies are not billed in the correct order, they will not pay for certain services. If you have questions, please call your insurance companies before you seek services.
Q: My bill had a doctor’s name on it who I did not see.
A: If you saw a physician assistant, the name on the bill is probably that of the supervising physician who is responsible for overseeing the recommendations and treatment made by the physician assistant. They work together as a team to ensure you have the best care possible.
You will get the most out of your health insurance if you read and understand your policy before you need to use it. You may want to call your insurance company if you have any doubts over whether specific services are covered.
Also, when you visit a health facility make sure you have your current information about your insurance policy, including an up-to-date address. If the hospital has sufficient information with which to bill, the process will go more smoothly for both you and our business office.
If, after calling your insurance company you still do not understand some aspect of your bill, please call the hospital and you will be directed to the appropriate person in the business office depending on your insurance.
The terms and policies laid down by insurance companies are frequently difficult to interpret or remember when the time comes and you need to seek medical care. MDI Hospital is currently working on a plan to make understanding your bill easier. By answering some of the commonly asked questions about Hospital billing, we hope to increase your understanding and save you money.
Q: Why do I have more than one bill for some of my services?
A: If you are seen at your doctor’s office, you will receive a bill from MDI Health Centers for the visit. If you are seen in the hospital or have lab work done at the doctor’s office, you will receive a bill from Mount Desert Island Hospital.
You may also receive a bill from an outside provider, such as the radiologist who reads your CT scan or X-ray, or an outside laboratory that processes a specimen (such as Dahl Chase).
Q: Why do I have a co-payment?
A: Your insurance company and your individual policy determine your co-payment amount. Because of the variation in insurance policies, any questions regarding this amount should be directed to your insurance company directly.
Q: What is the difference between Medicare Part A coverage and Medicare Part B coverage?
A: Medicare Part A coverage covers inpatient hospital charges only. Medicare Part B covers outpatient charges such as doctor’s office charges, laboratory, and radiology charges.
Q: Why do I receive so much correspondence after my hospital/doctor’s office visit?
A: In addition to the hospital bill, most insurance companies send out an Explanation of Benefits. This letter explains which services were billed to the insurance company as well as what the insurance company has covered and what you are expected to pay for. This is done to help you understand what your insurance company will cover and ensure that the correct services were billed to the insurance company.