What to Expect Prior | After Services are Rendered | Professional Physician Billing

What to Expect Prior to Scheduled Services

Seven Rivers Regional Medical Center employs an outstanding insurance verification and pre-registration team. Once you or your physician schedule services with Seven Rivers Regional, our pre-registration team begins preparing for your visit immediately.

• An insurance verifier will begin by contacting your insurance company to obtain benefits for the services scheduled.  If an authorization number is required for the scheduled test, the verifier will contact your primary care physician to insure an authorization is obtained.

• The insurance verifier will calculate your estimated patient liability and detail your benefits and estimated liability in a letter that will be mailed to you prior to your scheduled services.

• If the insurance verifier team experiences any delays in benefits or authorization for services, you will be contacted promptly.

After Services are Rendered

A summary of your charges will be mailed to you shortly after your discharge.  Upon request, we will gladly submit to the patient or the legal guardian an itemized statement detailing charges.

As a courtesy to our patients, we will bill the insurance carrier on your behalf. However, payment is the ultimate responsibility of the patient. It is important to present your insurance card with accurate information at the time of admission. Please ensure that Admitting has collected all necessary information before you leave the hospital.
 
The daily hospital rate includes the cost of your room and general nursing care.  There are separate charges for items, which apply to your care such as medications, operating room, oxygen, blood products, recovery room, laboratory services, and diagnostic x-rays.

Our billing cycles depend upon the type of insurance you carry.  The different categories are as follows:

• Worker's Compensation
• Medicaid
• Medicare
• Commercial/Blue Cross/CHAMPUS/Managed Care (non-HMO)Self Pay (no insurance)

Worker's Compensation

Patient statements are not generated under this category.  The hospital will follow up with the employer and/or insurance carrier until the account is paid.  It is the patient's responsibility to follow up with their employer to file a Workers' Compensation claim and to provide that claim number to the hospital.  If the claim is denied, the account will be updated to a self-pay account and will be pursued per the guidelines listed under self pay.

Medicaid

Patient statements are not generated under this category.  The hospital will follow up with Medicaid until the account is paid.  Medicaid is the payer of last resort, which means the hospital must bill any health insurance, auto insurance or liability insurance first before billing Medicaid.  It is the patient's responsibility to provide all insurances at the time of visit.

Medicare

Patient statements are not generated under this category.  The hospital will follow up with Medicare until the account is paid.  After Medicare has paid, the deductible and/or coinsurance will be billed to the secondary (supplemental) insurance if applicable.  The hospital will follow up with the insurance company per the guidelines listed below under Commercial/Blue Cross/CHAMPUS/Managed Care.  If the patient does not have supplemental insurance, the hospital will follow the  Self Pay guidelines. 

Commerical/Blue Cross/Champus/Management Care (Non-HMO)

A hospital claim is filed to the insurance company in most cases three days after discharge.  If payment has not been received from the insurance company within 30 days of filing, a statement is mailed asking the patient to follow up with their carrier.  If payment is not received within the following 2 weeks, a second statement is mailed advising the patient that the responsibility for the bill now belongs to the patient.  The account will then update to a self-pay and the hospital will follow self-pay guidelines.  Exceptions to this process may exist if the patient in engaged in resolving the account.
 
Seven Rivers Regional files insurance claims for our patients as a courtesy.  We will attempt to collect the money from the insurance company, but ultimately the hospital bill is the patient's responsibility.  We encourage all patients to contact your insurance carriers to assist us in resolving any delays in payment for your account.  In most cases, an insurance company will respond to a patient call quicker than a hospital call. 

Self-Pay

A statement is mailed approximately one week from discharge asking for payment.  A second statement is mailed two weeks later asking or payment in full or that acceptable payment arrangements be made with the business office (account must be paid in full within 6 months).  In addition to the above steps, phone calls are made to patients in this category asking for payment or to set up arrangements. Please remember, we are neither a bank nor a financial institution and cannot accept long-term payment arrangements on patient accounts.  Accounts, which are not satisfied by one of the above methods, will be forwarded to a collection agency for further collection action.

Should you have questions about your bill, please contact one of our financial counselors in the Business Office at 352.795.8318 or call the telephone number listed on your statement.
 

Professional Physician Billing

The physicians involved in your care will bill you separately from the hospital. These physicians may cover hospital-based services such as anesthesiology, radiology, pathology or emergency medicine. In addition, you will receive a bill from any other specialists involved in your care. If applicable, you may receive a bill from the: 

• Emergency Physician for any services received in the Emergency Department
• Radiologist for the reading of x-rays, mammograms, ultrasounds, etc.
• Pathologist for any laboratory and/or pathology test(s) evaluations
• Anesthesiologist for any services received during a surgical procedure
• Attending Physician/Hospitalist for the services they provide during your hospital stay
• Consulting Physician if your attending physician has requested they review your plan of care for any special needs
• Wound Care Physician for any services received at the Seven Rivers Rehab & Wound Center

All physicians directing patient care to the patient are independent contractors with the patient and are not employees or agents of the hospital. These physicians may or may not be individually contracted with your insurance company. And the insurance contracts that Seven Rivers Regional has may or may not be the same. Contact your insurance company to verify that both the hospital and the physician are contracted with your insurance provider network.
 
If you have any questions regarding these bills, call the physician-specific billing offices directly using the telephone number listed on the statements sent to you.