Hospital Bills & Insurance
Your Hospital Bill
The hospital is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. Remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment. Your bill reflects all of the hospital services you receive during your stay. Charges fall into two categories: a basic daily rate, which includes your room, meals, nursing care, housekeeping, telephone and television; and charges for special services which include items your physician orders for you, such as x-rays or laboratory tests.
If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.
Your insurance coverage is a contract between you and your insurance company. Benefits will vary depending upon the type of insurance policy you carry. You will need to present your insurance card(s) at the time of service. Your card(s) will be copied to ensure that the correct information is available or if your visit should be billed to another party, we will give you a form to complete and return so that we may submit your bill correctly.
As a courtesy to you, Trinity will bill all your insurance providers, provided you submit all the necessary information. You are responsible for any portion of your charges remaining unpaid by your insurance company. That includes non-covered services, co-payments and deductibles. It is your responsibility to be aware of any exclusions, benefits, co-payments and deductibles outlined in your insurance plan. Co-payments and deductibles are due before leaving the hospital and can be paid with cash, debit card, personal check or credit card. As a patient you should familiarize yourself with the terms of your insurance coverage so you understand the hospital's billing procedures and charges.
If your insurance does not pay within 60 days, you will be billed for the full balance. If you feel that your insurance company should have paid your bill, you should contact your insurance company or our customer service center at (888) 343-4165.
If we do not have exact patient liability at the time of service, we may require a deposit. The deposit may vary, depending on the particular type of service.
If there is a question about your insurance coverage, a member of the Patient Access Department will contact you or a family member prior to your visit or while you are here. This insurance information is needed in order to process your claims.
If You Have Health Insurance
We will need a copy of your identification card. You will be asked to assign benefits from the insurance company directly to the hospital.
If You Are a Member of an HMO or PPO
Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan's requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered.
If You Have Insurance Non-Contracted with Trinity/HMO Plans
If you are covered by an HMO-managed care plan, your insurance may restrict where you receive care. If you have services outside of your network, you will be responsible for your hospital charges. Check with your insurance company to ensure your provider is in-network.
If You Are Covered by Medicare
Trinity is a Medicare provider. Medicare patients must present their current cards at the time of service to verify eligibility and process your Medicare claim. Medicare patients are requested to pay their deductible at the time of admission. Deductibles and co-payments are the responsibility of the patient.
Medicare requires that all tests have supporting diagnosis to demonstrate the test is medically necessary. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others.
If your physician orders a procedure or service that does not support medical necessity, you will be asked to sign an Advanced Beneficiary Notice (ABN). The ABN informs you in advance that Medicare is not likely to pay for the procedure. You will then receive a hospital bill for payment of the service provided. You have the option of agreeing to be financially responsible for the procedure by signing the ABN or refusing the tests or services. If you refuse the test or service, you will be asked to sign a form indicating that you have elected not to have the service. If you request the service and will not sign the ABN, you will still be responsible for payment.
If You Are Covered by Medicaid
We will need a copy of your Medicaid card. Medicaid has payment limitations on a number of services and items and does not pay for the cost of a private room unless medically necessary. Our Medicaid Specialists and Financial Advocates can assist you in determining if you might be eligible for Medicaid or other state or federal programs. These programs provide comprehensive coverage including prevention, primary care, hospitalization, prescription and other services for individuals, families and children. You will need to complete an application and provide supporting documentation to determine if you qualify.
If Pre-Certification is Required
If your insurance requires a pre-certification for service, we will attempt to obtain all required clinical information from your physician to obtain the authorization from your insurance company. If you have any questions regarding pre-certification, please let us know. If we are unable to obtain pre-certification, we may need to cancel or reschedule your service(s).
If you were recently covered by insurance under a group health plan, you may be eligible to pick up those benefits to assist you with your medical bills. Our Financial Advocates can assist you in determining if you might qualify for COBRA benefits.
If services you are requesting are the result of a work-related injury, Trinity will bill your employer or your employer's liability carrier.