Your Medical Bill

Complex hospital billing processes and insurance company rules are confusing for most people. We would like to share a summary of Warren General Hospital’s financial policies and billing procedures with you. We hope that you find this information helpful in understanding how the health care services that you receive are billed and paid for.

Please direct comments or questions to:
Patient Accounts Department at 726-2330 (locally)
or call toll free at 1-800-777-9441.

Warren General Hospital wants to ensure that the billing and payment of your account is as accurate and efficient as possible. You can help us in this process by:

Notifying the registration clerk at the time of service about all of your insurance coverage and any changes to your insurance coverage since your last visit. You will be asked for your insurance card and proof of ID at time of registration. Proof of ID is to ensure that WGH is providing service to the person identified on the insured’s policy. It is extremely helpful if you can provide the registration clerk with your insurance cards.

Become familiar with your Plan’s benefits and exclusions. Benefit plans differ widely between employers and only you have specific information as to what your plan covers.

Review your summary bill for accuracy. If you would like a more detailed listing of the services provided to you, please call the Patient Accounts department and we will be happy to mail you an itemization of your charges.

Request an Itemization of Charges. Please contact the patient accounts department if you would like a detailed listing of all charges. We will be happy to mail this to you.

Monitor the activity of your insurance company in making payment for services rendered to you or a family member. Pay attention to letters and notices received from your insurance company. If you have questions, please call. Your voice has the greatest impact on claim payments and denials. Respond in a timely manner to your insurance company’s request for additional information. Most insurers will hold or “pend” a claim until this information is received and no payment will be made to the provider.

DOCTORS’ FEES ARE SEPARATE

Our community is fortunate to have skilled physicians. The physicians that interpret imaging studies, lab specimens, perform surgery, and administer anesthesia bill a fee for their professional services that is separate from your hospital bill.

Some of these physicians include Warren Radiology, Warren Surgeons, and Warren Pathology. Therefore, when organizing your medical bills, it is helpful to organize by date of service to ensure that bills from all sources are included. You will receive a separate bill from these physicians if their services are required during your hospital stay.

Physicians independently establish their fees and decide whether or not to participate in programs such as Medicare, Medicaid, Blue Shield, and HMOs/PPOs. If you have any questions regarding physicians’ fees or their participation in your health plan, you should discuss them with your doctor.

MEDICARE/BLUE CROSS* / COMMERCIAL INSURANCE

Warren General Hospital Patient Accounts staff will bill your insurance directly. Payment is usually made directly to the hospital. If you have a Medicare supplemental policy, or a secondary policy, we will also bill this on your behalf once your primary insurance pays or denies a claim. Any deductible or co-pay amounts not covered by your policy(ies) will be billed to you.

*Excluding Security Blue and Freedom Blue. PLEASE NOTE: Warren General Hospital is NOT a participating provider in Security Blue, Highmark Blue Cross’ Medicare HMO product or Freedom Blue Highmark’s Medicare PPO product.

MEDICAL ASSISTANCE

It is important to provide your “Access” card to the registration clerk at the time of service. We will verify your eligibility electronically with the Department of Public Welfare of Pennsylvania. Recipients of medical assistance are usually required to pay a minimal co-payment or deductible. All plans also have non-covered items. NOTE: Please be prepared to pay the cashier at the time of discharge. If payment in full is not possible, our billing department will help you arrange a payment plan. Only pregnant women, children under 18 years of age, and nursing home patients are exempt from this rule.

WORKMEN’S COMPENSATION / AUTO CLAIMS

Warren General Hospital will bill these claims directly to the appropriate insurance company on your behalf. Payment will generally be made directly to the hospital.

Report the Claim – It is very important that you report these claims to your employer/auto insurance agent so that a claim number is assigned. Payment will not be made if the injury/accident has not been reported and a claim number assigned.

Provide Information – Our Registration Clerk or Patient Account Rep. will provide you with a Workman’s Compensation or Auto Insurance information questionnaire. Your employer or auto insurance agent should complete the form and return it to the Hospital, postage paid by Warren General Hospital.

Because accidents are a common cause of injuries reported on these claims, it is customary for insurance companies to request “accident detail information” from the patient. Please respond to these requests, as the insurance carrier will not make payment until they receive your response.

UNPAID AUTO CLAIMS

Occasionally, auto claims remain unpaid past the normal time frame, despite our submission of all pertinent information, medical records, etc. For this reason, if an auto insurance claim remains unpaid after 120 days from the date of service, the balance will become the patient/guarantor’s responsibility.

LIABILITY CLAIMS

Warren General Hospital does not bill claims where personal liability is involved. The account is considered a self-pay account and the guarantor is responsible for payment of the account.

MANAGED CARE PLANS (HMO’S, PPO’S, POINT-OF-SERVICE PLANS)

Warren General Hospital is an approved provider in a number of managed care plans. Please call Patient Accounts to make certain your Plan is one of them.

Pre-certification Requirement - A common feature of a managed care plan is the requirement of a pre-certification prior to an admission to the hospital, or provision of outpatient services. We will work closely with your physician to ensure that pre-certification takes place when necessary and in a timely manner. You should phone your insurance company in advance (for NON–EMERGENCIES) to determine pre-certification requirements.

Patient Co-Pay Responsibility – Another common feature is that the patient is responsible for co-pays specific to the service provided. They are commonly required for emergency room visits, office visits, clinic visits, etc. This co-payment is to be paid at the time of service.

PATIENT RESPONSIBLE FOR BALANCES AND SELF-PAY

Warren General Hospital extends payment programs for account balances, which are the responsibility of the patient (either from the outset or after insurance(s) have made payment.)

The payment options are:

10% Prompt Pay Discount - Individuals may choose to receive a 10% prompt pay discount for outstanding self-pay balances if the balance is paid within 30 days of the first statement. Personal check or approved MasterCard and VISA can make payment.

Revolving Credit - Individuals who do not use the prompt pay option will be automatically referred to CSI’s revolving credit program. CSI is a medical receivables management company. It is NOT a collection agency. You will receive notification when your account has been transferred. You will always have the option to pay the account in full, interest free, within the first 30 days.

If you require more than 30 days to pay your medical bills, you have the option to make payments through CSI. CSI Financial will send a statement each month. The minimum payment is listed on the statement. CSI Financial requires 4% of the balance, or $20.00, (whichever is greater) as a minimum monthly payment. You may pay the account in full at any time.

CSI Financial charges interest on your account at the rate of 1.25% monthly (15%) APR) after the initial 30 day grace period. In the event that CSI Financial is not an option, Warren General Hospital will apply finance charges at a monthly periodic rate of 1.5% or an APR of 18%.

FOR THOSE IN NEED OF SPECIAL ASSISTANCE

For those who are admitted for non-elective procedures and do not have any or inadequate health insurance coverage, WGH offers assistance in completing the application for Pennsylvania Medical Assistance benefits and forwarding it to the Department of Public Welfare.

Warren General Hospital has always provided charity care to those persons who do not qualify for Medical Assistance but still need financial assistance.

The guidelines are based on 200% of the current Federal Government Poverty Income Guidelines. To make certain that appropriate resources are offered to these patients, Warren General Hospital considers each request individually. This will include a review of federal tax returns, current pay stub verification, a Medical Assistance denial of benefits, a review of personal assets, and a letter from the physician outlining the medical need for the service.

For individuals who qualify, entire balances may be written off as charity care or discounts may be applied to service charges using a sliding fee which is based on annual income and family size. For example, if an individual’s annual income is between $24,000 and $30,000 $27,000 and $34,000 with four in his/her family, the individual may qualify for a 60% discount on outstanding account balance for appropriate hospital services provided.

PRIVATE ROOMS

Limited private rooms are available on a space available basis. The additional cost is generally not covered by insurance if the private room was not medically necessary and you will be responsible for the difference in cost.

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