Hospital bills. Insurance claims. It can all be so confusing. Avera is here to help you understand. Find out how we bill patients, convenient payment options and learn more about financial assistance options available.
How Your Insurance Gets Billed
It’s important to know your insurance company’s coverage requirements. To receive the full insurance benefits available to you, please keep the following helpful tips in mind.
- Some health insurance plans require you to go to an in-network or participating provider doctor, clinic or hospital for covered care. Your insurance policy will detail this out.
- Most insurance companies cover the cost of emergency medical services. Some may ask you to go to an in-network hospital if possible.
- Going to an “out-of-network" hospital in a non-emergency situation could mean you have to pay more.
- You may be required to get approval to receive certain medical services. Or you may need to let your insurance know within a certain period after hospitalization to get covered.
- For elective procedures, always ask your physician’s office and your insurance company about coverage.
- Before a procedure, it is your responsibility to make sure insurance is approved. When needed, obtain required prior authorizations, submit referral or claims forms and complete a coordination of benefits. We will assist in the preauthorization process for procedures and tests.
Government Health Insurance
Medicare Claims
Avera will complete and file your Medicare claims for you. You will receive an explanation of benefits and coverage from Medicare. Any remaining amount due will be paid by your Medicare supplement or will be your responsibility. During registration, please inform Avera staff of any Medicare supplement policies you have or other coverage.
For hospital stays, Avera complies with Medicare’s regulations. This could mean you may be issued a denial of coverage if conditions do not meet approved criteria for hospitalization. If denied, Avera staff will work with patients and families to find other resources.
Medicaid Claims
Medicaid, or Medical Assistance Programs, are administered by your state or county. If you qualify, it is your responsibility to let Avera business offices know immediately. Medicaid claims must be processed within four months of your visit. Please provide evidence of eligibility on the day of your visit. Without this information, we are unable to process your claim.
Clinic and Hospital Service Registration
When you register, please do the following:
- Bring your driver’s license, photo ID, insurance cards and authorization forms.
- Let the clinic or hospital staff know if you’ve been cared for at another Avera facility previously.
While at registration, you will receive details on how your health information is used for insurance claim submissions. (For Minnesota residents, we will ask for your permission before releasing health information to your insurance company.)
Statements You Receive After Services
Avera bills your insurance company, Medicare, Medicaid and additional insurance payers on your behalf. You will be notified with:
- An explanation of benefits from Medicare or your insurance company for a breakdown of expenses, deductible and the balance you owe
- Easy-to-read billing statements with the most current balance owed by insurance or due from you
The balance owed will become your responsibility if your insurance company does not make a payment within a reasonable period of time (usually 60 days after billing). If a patient doesn’t qualify for financial assistance and the account goes into nonpayment status, there may be additional actions to collect payment for the amount due, as outlined in this policy.
Medical Payments Explained
Hospital Bills
Your bills show charges for all the services you received.
- Basic daily rate, including room, meals, nursing care and housekeeping
- Specialty services, including lab tests and X-rays
Physician Bills
You may receive bills from physicians and specialists who diagnose and interpret tests. They include pathologists, radiologists, anesthesiologists and other physicians. These professional fees are not included in your estimate. This means your final bill may differ.
Making Payments
Payment is your responsibility. Please make timely payments on your portion of the bill. Exceptions include approved Medicare, Medicaid, TRICARE and HMO services. Avera accepts cash, personal checks, debit cards, money orders and certain credit cards. Interest-free extended payment options are available to those who qualify.
At the time of service or discharge, you may be asked to pay deductibles, co-payments or other amounts. You may also be asked to pay if you do not have insurance coverage.
