Understanding Your Insurance
Health insurance coverage is a major concern for all patients and their families.
You may be wondering if medical care at Hackensack University Medical Center will be covered by your insurance policy. The following information has been developed to help patients understand insurance coverage at Hackensack University Medical Center and to make the process of becoming a patient here as easy as possible.
To ease your admission to the hospital, we will begin the paperwork as soon as your doctor informs us of your admission date. A pre-admission coordinator will call you at home to verify basic information, such as the name of your employer, your home address, and the type of insurance you carry. If you prefer, you may call us at (551) 996-2101 to complete the process.
We recommend that you familiarize yourself with the type of coverage provided by your health insurance and that you know whether you've met all necessary terms. If you belong to an HMO or an MCO, be sure your primary care provider is aware of your impending hospitalization and is prepared to submit a referral to authorize your admission. On the day of your arrival, you may be required to pay a deductible or co-payment. In certain cases, an admission deposit (based on your estimated length of stay) may be required. The pre-admission coordinator will discuss the deposit with you.
Understanding the Details of your Insurance Policy
The amount of coverage your plan will provide for care at Hackensack University Medical Center will vary depending on:
your insurance company
the amount of coverage you or your employer has purchased as part of your healthcare benefits package
your specific policy
To begin, you should contact the Customer Service or Member Services Department at your insurance company (the phone numbers are on your insurance card or in your benefits book). They should be able to tell you about your in-network and out-of-network coverage for care at Hackensack University Medical Center, as well as what your financial responsibility will be. A list of questions found at the end of this section can help guide your discussion with your insurance company.
Many insurance companies limit payments to medical providers using their own fee schedule of usual, customary, and reasonable (UCR) allowances. The fees you incur for medical services at Hackensack University Medical Center may differ from those allowed by your insurance plan. You will be responsible for the payment of any fees not covered by your plan, including any balances resulting from UCR fee limitations.
If you are unable to pay your bill, Hackensack University Medical Center’s financial counselors are committed to working with you. You may contact a financial counselor by calling 551-996-3348.
Participating Managed Health Care Plans
Beech Street Corporation
Bergen Risk Managers, Inc.
CCN (now part of First Health)
Devon Health Services, Inc.
1199 National Benefit Fund
Group Health Incorporated (GHI – Qualcare Logo only))
Healthcare Payers Coalition
Horizon Blue Cross Blue Shield of NJ
Horizon NJ Health
Medical Center Employees only
Managed Health Network Inc.
MasterCare, Inc. (aka PPO Next)
One Health Plan of New Jersey, Corp (now Great-West Healthcare)
Oxford Health Plan (Including Oxford Medicare)
PHCS – Private Healthcare Systems
PPO Next (aka MasterCare, Inc.)
The above list consists of insurers that have contracted with Hackensack University Medical Center. Please note that Hackensack University Medical Center is not responsible for the accuracy of the information on these sites. Should you have an inquiry about the information on these sites, please contact them directly.
Only those insurers and managed care organizations that have contracted with Hackensack University Medical Center are included in this list.
Most physicians on staff at Hackensack University Medical Center are not employees of the hospital, but are health care professionals who may or may not participate with your insurance plan. If Hackensack University Medical Center participates with your plan, there is no guarantee that your physician does.
If you do not see your plan listed and would like to know if Hackensack University Medical Center participates in your plan, please feel free to call us at: 551-996-3355.
Frequently Asked Questions
Q. Should I bring my insurance card with me to the hospital?
A. Yes, the information on your insurance card is needed for the hospital to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign a few forms. This registration process goes much faster when you bring your insurance information with you.
Q. Will the Hospital file my insurance claim for my current visit?
A. Yes. The Hospital will continue to submit claims to your insurance company for you. As insurance companies require more information, however, the accuracy of your records is extremely important. Registration will facilitate prompt and accurate submission of your health insurance claim.
Q. I gave my insurance information to my doctor, why don't you have it?
A. Many physicians are independent contractors. Each maintains his or her own patient information. Also, your benefit coverage may be different for a physician than it is for hospital services. For these reasons, physicians and the hospitals retain separate insurance information.
Q. I'm covered under my insurance and my wife's. The deductible is less under my wife's insurance. Can you just bill her insurance and not mine?
A. Under a provision called Coordination Of Benefits, the hospital is obligated to bill the insurance that would be considered primary for you. Any medical insurance for which you are the primary holder must be billed before any other medical insurance.
Q. Even though I gave my medical insurance, I was later asked for my automobile insurance because my injury was due to an automobile accident. My medical insurance will cover the bill, why is any other insurance needed?
A.When we bill your medical insurance for treatment related to an accident, the carrier will want to know if there is any other insurance that may be liable for the bill. For Medicare recipients, this is a requirement to bill Medicare. If we cannot provide the information at the time of billing, the claim may be delayed, or even denied, until the information is given.
Q. How do I follow-up with my insurance company?
A. Most insurance company ID cards have a customer service phone number on the back. Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Write down the name of the person you talked to at the insurance company. If the bill has not been paid, find out when the anticipated payment date is, and ask what is needed. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor. Other key questions you should ask the insurance company customer service representative include the following:
Have you received the hospital's bill for these services?
Am I covered for these services?
When will you pay the hospital for these services?
What portion of this bill will I be responsible for paying?
What is the status of the account? If paid, ask when and to whom.
Q. Do I need to let my insurance company know that I'm going to be in the hospital? And what will they cover?
A. We encourage you to check with your insurance company or your employer regarding coverage. Because there are so many types of insurance plans, we do not know if you need prior approval or notification for your hospital stay. Contact your insurance company or your employer with specific questions about what is or is not covered by your insurance plan.
Q. How do I know if my insurance company will cover my visit or certain services?
A. Coverage varies with each insurance company. The hospital staff does not know whether a particular service will be covered. Medically necessary and appropriate services may not always be covered by your insurance contract. Please refer to your insurance member handbook or call your insurance company with questions.
Q. Why didn't my insurance cover some services?
A. Insurance policies vary on what services are allowed (paid). Your particular policy may not cover a certain service or you may not have met your policy's deductible and/or co-insurance. Our insurance billing staff can help you with any questions. Please call them at the number listed on your statement.
Q. 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?
A. Again, 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.
Q. How will I know if my insurance company has paid my bill?
A. 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 this bill in full or to set up payment arrangements by contacting our Customer Service office at 551-996-3355.
Q. What do I do if I disagree with how much my insurance company has paid on my bill?
A. If you have questions regarding the payment call your insurance company for an explanation of the payment. If the insurance company finds that an error was made, note the information and whom you talked to at the insurance company. Request an anticipated payment date and ask if they need anything to complete processing. 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 Frequently Asked Questions
Q. What is a Medicare Explanation of Benefits form?
A. The Explanation of Benefits form is an information document that Medicare sends to you after it has processed your medical claims. The Explanation of Benefits form provides you with information about the payment status of your bill.
Q. What is the difference between Part A and Part B Explanation of Benefits forms?
A. Part A covers inpatient hospitalization and Part B covers outpatient and physician services.
Q. What should I do with the Explanation of Benefits form?
A. We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the Explanation of Benefits from you before they will pay any remaining balance on your account.
Q. Why didn't Medicare cover my visit?
A. Unfortunately, Medicare will not pay for certain services (these may include physicals, some screenings, x-rays, and lab work). If you believe charges were denied in error, please call the phone number listed on your statement.
Q. Do I have to sign any forms before the Hospital can bill Medicare?
A. You will be asked to sign a Consent for Treatment form each time you receive services. You will also be asked questions each time you receive services that Medicare requires.
Q. I have health insurance in addition to Medicare coverage. Will you bill that insurance company also?
A. If you have given us information about your additional health insurance, we will bill that insurance company after Medicare has made their payment.
Q. Why do I have to give you information about other insurance if I have Medicare coverage?
A. Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill Medicare. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. In certain situations, the hospital must consider the possibility that another party may be responsible for your expenses before we bill Medicare. For example, if you were injured in a car accident, at your worksite, or on someone else's property, it is the hospital's responsibility to make sure those claims are filed appropriately. Consequently, we need to have complete information about all insurance coverage you have.
Q. Should I pay the balance that is listed as "your total responsibility" on the Explanation of Benefits form?
A. No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from your medical provider before making payment.
Q. Will I have to pay any money for my hospital visits?
A. As a Medicare patient, you will only be responsible for non-covered charges, co-insurance and deductible amounts. These amounts may vary depending on your Medicare coverage. We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know your responsibility, we will bill your other health insurance company (if you have coverage) for the balance. If you do not have other health insurance, you will be billed for the balance.
Questions for Your Managed Care Company
Use the following questions as a guide when you talk to your insurance company about your coverage options.
Q. What type of insurance plan do I have?
(Your insurance company might tell you that you have one of the following plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point of Service (POS), and indemnity insurance plans
Q. Is Hackensack University Medical Center in my network?
If so, here are some follow-up questions to ask:
Does my insurance plan cover physician costs, as well as inpatient and outpatient hospital services?
What, if any, are my co-payments?
Hackensack University Medical Center is not in my network, but my plan has out-of-network benefits.
If I choose to go out-of-network, what do I have to pay?
What is the amount of my deductible?
Q. If I go out-of-network, what percentage of my bill will be paid by the insurance company? (Examples: 80 percent paid by insurance/20 percent paid by patient, 70/30, 50/50, etc.)
Q. Is this percentage based on usual, customary, and reasonable (UCR) schedules or on the actual charges?
Q. Does my plan participate in any other preferred provider organization (PPO) networks that provide additional coverage? (Note: Check your insurance card as one of the following networks may be listed: Multiplan, Magna Care, Beech Street, Integrated Health Plans, Cancer Resource Services, and United Resource Network.)
Q. Does my policy have an out-of-pocket maximum?
Q. If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?
Q. If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Hackensack University Medical Center’s charges and usual, customary, and reasonable (UCR) rates?
Q. Before I see a doctor at Hackensack University Medical Center, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?
Q. Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my initial consultation with a Hackensack University Medical Center doctor?
*Note: Be sure to make note of the name of the person that gave you the answers to these questions and the date that you spoke to him or her.