Insurance Questions
- Should I bring my insurance card and picture ID with me to the hospital or clinic?
-
Yes, the information on your insurance card is needed to file a claim with your insurance company. When you register we will ask for information about your insurance coverage, picture ID and have you sign forms. This registration process goes much faster when you bring your insurance information with you.
- Will you bill my insurance company for me?
-
Yes, MercyOne will bill your insurance company, or companies. It is your responsibility to provide any requested information.
- Will you file Worker’s Compensation, motor vehicle accident or medical liability claims for me?
-
Yes, we will bill worker’s compensation insurance if the patient provides the information. Please file a “First Report of Injury” with your employer.
For other types of liability claims, we will bill your health insurance first, unless you have Medicare or Medicaid. At the time of registration or admission, you will be given a form to complete with the accident and insurance information. Please complete and return the form as quickly as possible.
- Do I need to let my insurance company know that I’m going to be in the hospital?
-
We encourage you to check with your insurance company or your employer notification requirements. Because there are so many types of insurance plans, it is difficult for us to tell you whether or not you need prior approval or notification for your hospital visit. Contact your insurance company or your employer with specific questions about what is or is not covered by your insurance plan.
- How do I know if my insurance company will cover my visit or certain services?
-
Benefits vary with each insurance company and employer. Generally, the hospital staff does not know whether a particular service will be covered. Medically necessary, preventive care and appropriate services may not always be covered by your insurance contract. Please refer to your insurance handbook or call your insurance company with questions prior to your appointment.
- How do I know if my insurance company will cover services provided by all professionals (i.e. anesthesiologists, radiologists, and pathologists) involved with my treatment?
-
We encourage you to check with your insurance company or your employer about this. Each professional needs to contract individually with insurance companies and the hospital does not know if each professional is contracted with your insurance company.
- How do I follow-up with my insurance company?
-
Before you call, have your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Ask for the status of the account. If it has been paid ask when and to whom. Write this information down as well as the name of whom you talked to at the insurance company.
If the bill has not been paid, find out when the anticipated payment date is and ask if they need anything from you. If the bill does not get paid in the timeframe, follow-up with the insurance company again, and if necessary, request to speak to a supervisor.
- How will I know if my insurance company has paid my bill?
-
Each insurance company sends an Explanation of Benefits (EOB). This will explain what was paid or not paid and why. If there is a balance due from you after the insurance company has paid its portion, we will send you a statement. This statement indicates the amount that has been paid and any balance you are required to pay. This is your bill. You are required to pay the bill in full or contact our office to make payment arrangements.
- What do I do if I disagree with how much my insurance company has paid on my bill?
-
If you disagree with the insurance company’s payment amount, contact the insurance company and ask them to review how the claim was processed. If the insurance company finds that an error was made, make a note of the information and whom you talked to at the insurance company. Request an anticipated payment date and ask if they need anything from you.
If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an appeal with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration.
Medicare Patients:
Effective January 2002, Medicare patients seen by a MercyOne clinic physician will be billed under Hospital-Based Physician status. This designation requires Medicare patients to be billed in two parts - a physician fee billed by MercyOne Clinic and an outpatient facility services fee billed by Waterloo Medical Center. Questions can be directed to 319.272.7373.
Affordable Care Act:
This fall, through the Affordable Care Act, consumers will have a variety of quality, affordable insurance options available around the country. For more information about who qualifies click on the resource links below:
Please watch Catholic Healthcare Association’s new “Ready, Get Set, Enroll video”.
Get Covered America is also providing enrollment resources at www.getcoveredamerica.org
