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Frequently Asked Questions - Insurance

Here are some frequently asked questions and answers regarding insurance.

How do I know if my health plan includes MercyCare Community Physicians?

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MercyCare Community Physicians participates in most major health plans in our community. In addition, please review your health plan provider directory and/or consult with your health plan to confirm coverage.

How will Mercy Medical Center know in which health plan I participate?

Please present your current health plan identification card when you register for inpatient or outpatient services at MercyCare Community Physicians.

What is the difference between an HMO and a PPO?

Health Maintenance Organizations (HMOs) require a patient to select a Primary Care Physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors and other medical professionals, that as a patient, you must use to be covered for that service. 

Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize healthcare providers within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.

What does "in-network" and "out-of-network" mean?

If you receive your health care services from a hospital, physician or other health care provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network."  See more about common insurance terms.

How do I know if my health plan requires a referral or pre-certification for a service?

Your benefit book or provider directory should provide this for you. If not, call the customer service phone number listed on your insurance identification card.

What should I do if my health plan includes MercyCare Community Physicians as a participating provider, but I receive an explanation of benefits stating I am out-of-network?

Consult your health plan or call MercyCare Community Physician's business office at (319) 369-4505.

What if I have questions on my bill?

If you have questions about your Mercy Medical Center bill, or feel that it is incorrect, call (319) 369-4505 between 8:30 a.m. and 4:30 p.m. Monday through Friday. Please have the Patient's name, account number(s) listed on the bill or the patient's social security number ready when you call.