Here are some frequently asked questions and answers regarding billing.
Why did I receive separate bills for the hospital and the doctor(s)?
These bills are for professional services provided by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, and other specialists perform these services and are legally required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you received from them.
Will you bill my primary and secondary insurance?
You will need to provide us with complete primary insurance information. As a courtesy to our patients, Mercy submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.
Are itemized statements automatically sent to patients?
No. We send summary bills to the patient. To request a itemized detail, call us at (319) 398-6856. Phones are answered between 9 a.m. and 4:30 p.m. Monday through Friday.
Do you offer payment arrangements?
Yes, payment arrangements may be made by contacting us at (319) 398-6856. Phones are answered between 9 a.m. and 4:30 p.m. Monday through Friday.
Why is this billed as an outpatient service when I spent the night in the hospital?
For an account to be billed as an inpatient service there must be a physician order. The physician who ordered your services determined that your condition did not meet the requirements for an inpatient admission. The physician's written order dictates whether we bill as an inpatient or outpatient.
Why am I receiving a refund check?
There was an overpayment to your account. Either you paid too much on the account and/or your insurance paid at a later date and covered some of what you already paid.
Why did my insurance deny the claim?
One or more of the following may apply:
- The service you received was not covered under your plan.
- You did not provide the correct insurance information at the time of service.
- The service you received was from a physician outside your plan's network.
- You were not covered by your plan at time of service.
- Your primary care physician did not process a referral for the services or an authorization was not obtained prior to the services being rendered.
Can I come in and talk to someone regarding my bill?
Yes, our Patient Financial Counselors are here to assist you from 9 a.m. to 4:30 p.m. Monday through Friday.
Must I register each time I come to the hospital?
Yes, information gathered from patient registration is stored in our computer system. We retrieve this information each time the patient returns for services and we ask the patient to verify that the information is current and accurate. Medicare requires that specific questions be asked to determine whether Medicare or another payor is primary. Your assistance in verifying the information is always appreciated.
I don't have any insurance. Is there any help available?
Mercy Medical Center's policy is committed to providing quality healthcare to all persons regardless of their financial status. The Medical Center has developed the following guidelines in an effort to assist those who are in need of such assistance in a fair, non-discriminatory manner. In keeping with Federal Legislation, Mercy Medical Center does seek full payment on all medical bills; however we intend to help our patients in developing a payment plan or making other payment arrangements. The hospital financial counselors can help you identify ways you can fulfill your financial responsibility. Please contact Patient Accounts at (319) 398-6856 to speak with one of our financial counselors. Phones are answered from 9 a.m. to 4:30 p.m. Monday through Friday.
I come to the hospital often. Is there any way that I can receive one bill?
Unfortunately, because of insurance requirements, we may be required to bill each visit separately.
Why is there an error on my bill?
If you have questions about your bill, or believe that it is incorrect, call the billing office at (319) 398-6856 between 9 a.m. and 4 p.m. Monday through Friday.
What is a co-payment?
A co-payment is a set fee the member pays to providers at the time services are rendered. Co-pays are applied to emergency room visits, hospital admissions, office visits, etc. The costs are usually minimal. The patient should be aware of the co-payment amounts prior to the date of service. See more about common billing terms.
What is a deductible?
Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are paid. For example, if a member's policy contains a $500 deductible, the member must accumulate and pay $500 out of pocket before the insurance carrier will pay benefits. Once the patient has met their deductible, the carrier usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are yearly, usually starting in January. See more about common billing terms.
What is co-insurance?
Co-insurance is a form of cost-sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient. See more about common billing terms.
Why did my insurance company only pay part of my bill?
Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Please contact your insurance company for specific answers to your questions. You may have out-of-pocket expenses.
Why do I need to call the insurance company if they do not pay the bill?
If you have a PPO policy, you are ultimately responsible for the total bill or any portion of the bill your insurance carrier does not pay. The Central Billing Office will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance.
If I have an HMO policy, can I be billed if they do not pay?
If you have an HMO policy, you should only be billed for the amount specified on your explanation of benefits (EOB) that is provided to you by your insurance carrier. This usually includes co-pay amounts, deductibles and non-covered services.
I belong to a managed care plan. What should I do before coming to the hospital?
Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process, if you receive a verbal authorization number, please provide us with this information at registration.
I belong to a managed care plan but needed to be seen in the emergency room; what should I do now?
After receiving services, if you did not contact your primary care physician or your insurance plan before you came to the emergency room you will need to contact them within 24 hours explain the circumstances and ask for authorization.