Women's GAMEPLAN for Health

Billing and Payment

Upon discharge, your charges for services provided will be summarized on a uniform bill. This bill covers the Hospital's cost of your care which includes supplies, equipment, technical personnel, nursing care, etc. It does not include the professional services of your own private or other Hospital-based physicians. You will be billed directly by your own doctor and/or by any other physicians who assisted him or her with your care while you were a patient here.
 
Hackensack University Medical Center bills third party insurance carriers directly. Any secondary insurance carriers will be billed to the extent that you provide this information to our Admissions Office. Many insurance carriers now require you to pre-certify any inpatient hospital stay including emergency admissions.
 
Pre-certification is your responsibility. Failure to pre-certify may result in additional financial responsibility on your part. Please call the Admission Service Center at (551) 996-2101 if you need assistance. A deposit will be required for that portion of your bill not covered by insurance, including co-payments, deductibles, and certain convenience items.
 
Any balance due after insurance payment and/or deposits made will be billed directly to you.
 
If you are in need of additional information about how your bill is calculated, or if you are concerned about anything on your bill, please contact the Customer Service Center at (551) 996-3355 and someone will assist you.

 

Understanding Your Bill

Your bill has several sections that contain information about your visit and treatment. The descriptions below take you through each section of the bill. Learn more about billing terminology in our Glossary.
• DATE — The date of your visit or treatment.
• DESCRIPTION OF SERVICE — The service or treatment you are being billed for.
• CPT CODE — The CPT (current procedural terminology) coding system used to describe what treatment or services given to you by your doctor.
• TOTAL CHARGES — The charges for services and treatment.

 

Ensuring Accurate Billing

Here are a few things you can do before your visit:
• When scheduling your appointment, pre-register with your provider, and make sure the correct information is in the billing system.
• Obtain pre-certification or referral from your insurance company.
• Understand your insurance coverage
• Make sure the hospital accepts your insurance plan and that the plan covers the specific test(s) or visit you are scheduled for.
• Review information on the insurance website.
Make sure you have a good understanding of what is and is not covered by your plan.
• Ask questions!
• Get contact information for financial questions you may have after your visit.
• While you are at the hospital or physician's office:
• Verify that the information on file is correct and current. In particular, look at your name, address and insurance information.
• Verify that the hospital accepts your insurance plan.
• Review billing and registration information and keep these as a reference.
• Ask the provider to estimate the amount of out-of-pocket expense you may incur.

 

Billing Frequently Asked Questions

Q. When will I receive a bill?
A. Bills for services rendered are sent only after all third parties (e.g. insurance companies) have been billed. If you have insurance and are receiving bills or statements from us, please check to see if your insurance company has paid their portion of your bill. If they have, the balance is likely your co-insurance or deductible. You may also receive a bill if services are not covered or if you have exhausted your benefit period or lifetime maximums. Please check with your insurer prior to services to confirm covered benefits and out-of-pocket responsibilities.

Q. Why have I received a bill?
A. The Hospital sends a bill to you to help you know as much as possible about the status of your bill and the status of payments. Please review your statement to ensure that charges submitted to insurance and payments received are accurate. The Hospital will continue to send you a statement until your account balance reaches zero.

Q. I don't understand my bill. What is all this terminology?
A. Billing for healthcare services often includes several different types of clinical and financial terminology. However, we are committed to making our bills as patient-friendly as possible including explanations for our terminology. Please refer to our Glossary included in this website as part of our Customer Service Center. If the form is not explained in our glossary, Please call our Customer Service Department at 551-996-3355 for further clarification.

Q. Who can I talk to with questions about my bill?
A. Patient Accounts Service Representatives are available to help you telephone with any questions or concerns you may have about your bill. Our representatives are available Monday through Friday, 8:30 a.m. to 4:00 p.m. Call 551-996-3355.

Q. Why do I get a separate bill for hospital services?
A. In order to send a claim to the insurance company, we are required to file a separate claim for each inpatient or outpatient visit. Depending on the types of services you received, you may receive separate bills for these different types of hospital services. Clinic bills are generally for fees such as physician or other provider services, lab tests, and x-rays. Hospital bills include technical fees for things such as hospital equipment and supplies, nursing care, room, and rehabilitation services.

Q. Who can I talk to with questions about my bill?
A. Patient Accounts Service Representatives are available to help you telephone with any questions or concerns you may have about your bill. Our representatives are available Monday through Friday, 8:30 a.m. to 4:00 p.m. Call 551-996-3355.

Q. What if I receive another bill with increased charges?
A. Occasionally we receive additional charges from ancillary departments after the initial bill has been sent.

Q. Will you bill my insurance company for me?
A. Yes, as a courtesy we will bill your insurance company, or companies. It is your responsibility to provide any requested information to your insurance company (accident information, claim forms, other health insurance information, or pre-existing condition information). Insurance claims are generally paid within four to six weeks after we have filed your claim.

Q. What should I do if I sustain a work related injury or if I am injured in an automobile accident?
A. To ensure your bill is submitted to the appropriate payer, please be sure to provide the worker's compensation or car insurance claim number when you register. You must complete your workers' compensation or auto insurance company's required paperwork in order for your claim to be processed.

Q. Will the hospital file my Worker's Compensation claim for me?
A. Yes, as a courtesy we will bill worker's compensation insurance if you as the patient provide the correct information.

Q. Why is everything so expensive?
A. Hackensack University Medical Center strives to provide our patients with the very best medical care utilizing the latest technology. Our fee schedules reflect the cost of delivering the level of healthcare that our patients desire and deserve. Our prices are driven by the increasing costs associated with delivering high quality healthcare.

Q. Why did I receive multiple bills from Hackensack University Medical Center?
A. If you have received more than one bill, please review them carefully and you will likely find only one is from the Medical Center. Most likely, you have received a bill from the physician(s) that saw you at the hospital. Physicians send bills for their services separately from the hospital. If Radiology and/or Pathology services are performed during your visit to the Medical Center, you may receive more than one bill. Generally, these bills represent fees for Technicians and Professional Services rendered at the Medical Center.

Q. It has been several weeks since my hospital visit, why haven't I received a bill?
A. We will always bill the your insurance carrier first. Once your insurance carrier has paid its portion of the bill, any remaining amount will be billed to you.

Q. How do I know that the amount you are billing me is the correct amount?
A. Once your insurance carrier pays its portion of the bill, the insurer will send you an explanation of benefits (EOB) to show how the claim was adjudicated. You can compare your EOB to the statement sent by the hospital. How the carrier adjudicates the claim is based on its negotiated or mandated rates with Hackensack University Medical Center and its contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution.

Q. I went to the emergency room with a stomachache. The Registrar at the desk could not tell me how much these services would cost me. She wouldn't even say if my insurance would cover the bill. Why couldn't I find this out before seeing the doctor and incurring a bill?
A. When someone comes to the Emergency Room, it is implied that they have a medical emergency. Very specific regulations require that we first determine the extent of the medical emergency before we can discuss any financial questions. Generally, true emergencies are covered by insurers. However, State Regulations require that we must first determine the extent of the medical emergency prior to discussing financial obligations with patients. The patient must be seen by the appropriate clinicians first. We appreciate that this restriction can be frustrating; however, the regulations are there to ensure everyone who comes to an Emergency Room will be seen regardless of their ability to pay.

 

Payment

FULL PAYMENT OF YOUR OUT-OF-POCKET EXPENSES will be required as follows:
INPATIENT ADMISSIONS - Three (3) business days prior to or on the date of your pre-surgical testing when the pre-surgical testing is performed at the medical center. If your pre-surgical testing is performed at another facility, full payment of your out-of-pocket expenses will be required no later than 12 p.m.(noon), 3 business days prior to your procedure.
 
OUTPATIENT PROCEDURES - No later than 12 p.m.(noon), 3 business days prior to your procedure.
This includes any deductibles, coinsurance and/or co-payments that may be due as indicated by your insurance company. Acceptable forms of payment are: Cash, Money Order, Credit Cards (Visa, MasterCard, Discover and American Express), bank checks and personal checks (if received 5 business days in advance of service). Failure to comply may result in the rescheduling of your procedure.
 
If you feel that you may be unable to pay for your care, you may be eligible for free or reduced cost care.

 

Denials and Appeals

Steps to Take if Denied Coverage
Here are some steps to consider if your insurance company initially does not allow coverage for your medical care at Hackensack University Medical Center:
  • Become educated about your insurance plan -- know the type of coverage it provides and the reasons that your coverage is being denied.
  • Learn about your illness and the recommended treatment options. Ask your Hackensack University Medical Center doctor if the recommended treatment is available only at Hackensack University Medical Center.
  • Write an appeal letter and follow the process for filing the appeal as outlined by your insurance company. Organizations such as the Patient Advocate Foundation (www.patientadvocate.org or 800-532-5274) offer guidelines for writing letters of appeal. You can also find sample letters of appeal on their Web site. Search on "Appeal Letter" from the home page of the Patient Advocate Foundation's Web site to find this information.
  • Ask your Hackensack University Medical Center physician to contact our Case Management Department for added support, or you can contact the Case Management Department directly at 551-996-2080.
  • Speak with your employer to request they discuss the situation with the insurer.
  • Speak to your union management and ask that they advocate on your behalf with both your employer and the insurer.
  • Remember to keep copies of all correspondence and notes of telephone and in-person conversations.

Your Legal Rights

  • You have the right to challenge any decision made by your insurance company that denies you coverage. Call your state Department of Insurance hotline to file a complaint.
  • The New Jersey State Insurance Department's new health complaint ranking shows that consumers are winning their appeals more than half the time.
  • If your health insurance plan denies you access to Hackensack University Medical Center, you may want to consider taking one of the following steps:
File a Grievance or Appeal with Your Health Insurer
HMOs and insurers with a managed care contract are required by law to have a grievance procedure. Refer to the member handbook of your health insurance plan, or contact their Member Services Department for information on their formal grievance and/or appeal processes.
A grievance can be filed for any decision except one concerning medical necessity. (An "appeal" is the process used to challenge a finding of "medically unnecessary;" see below.)
Examples of complaints that can be challenged through the grievance procedure include, but are not limited to, the following:
  • You are denied a referral to a specialist or other provider
  • You are denied coverage because a benefit is determined not to be covered under your subscriber plan
  • You are denied coverage or receive only partial coverage for a prescription drug
  • You are required to pay a specialist fee beyond the standard co-pay
  • You are denied a referral outside the HMO's network of physicians
Examples of procedures and services that could be challenged for medical necessity include, but are not limited to:
  • Bone marrow transplant
  • Magnetic resonance imaging (MRI)
  • Breast reconstructive surgery following mastectomy
  • Mammography
  • Artificial limbs and other prosthetic devices
  • Biopsy
File a Complaint with Your State's Department of Insurance
Within the State of New Jersey, consumers who are unable to resolve problems with their HMO's and insurers can file a complaint with the New Jersey Department of Banking and Insurance. You can visit their website at www.state.nj.us/dobi/index.shtml
 


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Translation service provided by Google. HackensackUMC is not responsible for the accuracy of translation or any other aspect of service provided by the GoogleTranslate tool. Users should not make medical decisions without first consulting with their physician.
 


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