Understanding the Registration and Billing Process
Many steps are involved with registration and health care billing. These
are the typical steps between the time you receive non-emergent
medical services and you receive your bill:
When you go to your hospital or health care provider's office
for care, the admitting or office registration department*
gathers information about you and/or the person responsible for
paying for the services (the guarantor) and the insurance
organization that will be billed. You will be asked to provide:
insurance card, photo identification, and a prescription or
order. Your physician may also be requested to obtain a referral
or pre-certification for your hospital visit.
You will be asked to sign several documents, including:
Acknowledgement that you have
received a Notice of
Notice (some Medicare
beneficiaries)—Advises you that
the test/procedures performed
may not be covered by Medicare.
The purpose of the Advanced
Beneficiary Notice is to let you
know in advance that these
services may not be covered and
to advise you that you will be
responsible for the Medicare
reimbursement rate for these
Advance Directive: You are also asked about an
Advanced Directive when you register for inpatient or outpatient
hospital services. Formal Advanced Directives are documents
written in advance of serious illness that state your choices
for health care, or name someone to make those choices, if you
become unable to make decisions. Medicare and hospital
accrediting bodies (organizations that oversee the quality of
care provided by hospitals) require we ask each patient, at each
visit, whether or not the patient has a current Advance
Directive. This could be in the form of a living will, health
care power of Attorney, or both. Through these documents you can
make legally valid decisions about your future medical
Most insurance plans require that you pay a co-payment,
co-insurance and/or deductible for your health care services
(patient responsibility). In some instances, your insurance
carrier may require a pre-certification for certain outpatient
services that have been prescribed for you. This is the
physician’s responsibility to obtain from your insurance
company. If your physician has not obtained a pre-certification,
your test or procedure may be cancelled or delayed.
Main Line Health representatives will present you with an
estimate of your co-payment, coinsurance and/or deducible based
on our understanding of your individual insurance coverage. It
is our expectation that this co-payment, coinsurance, or
deductible be made at time of service.
For your convenience we accept cash, check, Visa, MasterCard,
American Express and Discover Cards.
After the care or treatment is performed, the hospital’s billing
office files a claim with your primary insurance organization
for services. In many cases, payment is sent directly to your
health care provider, not to you.
If your insurance organization will not pay because of a problem
with the information provided, the billing office tries to
correct the information and re-files the claim.
After payment is received from the primary insurance
organization, the billing office will file claims with any
secondary insurance organizations.
When all insurance payments to the hospital have been processed
and paid by your insurance company, you are billed for any
remaining unpaid balance. You will receive a statement by mail.
As a courtesy to you, a payment representative (who will clearly
identify himself or herself and will ONLY ask you verifying
information) will call you 30 days after mailing your first bill
to determine if there are any matters which are unclear. We
encourage our patients to use this service call to address any
unanswered questions regarding the billing process.
It is important that you are familiar with your benefits and the
extent of your medical coverage. We suggest that you contact
your insurance carrier before scheduling an elective procedure
and before services are rendered.
Most hospital visits involve both physician and hospital
resources. Please be aware that physician charges are billed
separately according to the terms of your insurance plan. A list
of typical physician service organizations and contact
information can be found on the Billing
and Physician Group Contacts page. It is possible you will
receive only one hospital bill, but several physician bills
depending on the complexity of your care.
A Special Note to New and Expecting Parents
Most insurance companies require that a new child be added to
the parent’s policy within 30 days of birth. Failure to do so
could result in non-payment for the child’s hospital services by
the insurance company. If this occurs, the parent/responsible
party will be billed for the services. Please check with your
insurance company to determine when they require a new child to
be added to the policy.
Charity Care Policy
No patient will be refused emergency treatment at Main
Line Health because of their financial status.
For more information, call 1.866.CALL.MLH.