Billing & Insurance

About Your Health Insurance

Patient Insurance

As we strive to provide quality care, we must be mindful of insurance and payment issues. Health care organizations across the country are instituting new procedures to assist patients with the management of their health insurance and out of pocket expenses. We hope this information will assist you in understanding your insurance responsibility and our relationship with your insurance carrier.

Insurance

McKenzie Health System participates with many medical insurance plans. It is important to understand that your insurance policy is an agreement between you and your insurance carrier. We will submit the claim on your behalf, however that is not a guarantee of payment of the claim. Should your claim be rejected or only partially paid, your insurance company should send you an explanation of benefits. It will then be your responsibility to pay any remaining balance that your insurance does not cover. If we do not participate with your insurance plan, payment is expected at the time of service.

Payment

Co-pays, deductibles, co-insurances and fees for non-covered services are expected at the time of your service. For your convenience we accept cash, personal checks, Visa, MasterCard, American Express and debit cards.

Health Maintenance Organization (HMO) Plans

HMO insurance plans may require a referral from your primary care physician prior to you obtaining services for specialty care. As a patient, you are responsible for securing referrals from your primary physician prior to making an appointment to see a specialist.

If you arrive for an appointment with no referral you may be asked to:

o   Contact the primary care physician to obtain the referral

o   Reschedule your appointment

o   Pay the estimated cost of the service prior to seeing the physician

HMO insurance plans also require that testing such as laboratory work, X-rays, and physical/occupational therapy be completed at specific sites. As the patient, it is your responsibility to know which site you must use for tests and services. You may obtain this information through your primary care physician’s office, or your health insurance company’s member services department.

Preferred Provider Organization (PPO) plans usually offer a network of physicians and hospitals that you, the insured member, must select from when receiving health care. In these types of insurance coverage plans, you receive maximum benefits if you choose   in-network providers. You may also choose to “self-refer” to an Out of Network provider but a higher co-payment will most likely be applied and the plan may require higher deductibles and/or co-insurance amounts. If you choose this option, our staff in the patient accounting office can provide you with an estimate of the treatment plan cost. Should you elect to have the recommended services, diagnostic studies or other testing at one of our facilities, a deposit must be paid prior to receiving the service.

You may wish to have such treatment or tests performed by another provider who is a participating provider in your insurance carrier’s network. If you choose to do so, we will work with you to forward copies of your medical records to the other provider.

If your insurance plan states that it will only make payment to you (the patient), you will be required to pay in full for all services rendered.

McKenzie Health System provides financial counseling services to patients regarding their ability to pay for services. If you are uninsured, have concerns about your account or have other questions concerning your insurance coverage, please contact us at 810-648-3770.

The Billing Process

Patients will receive one monthly statement for all services from the hospital. Patients are billed as soon as possible after receiving services from their physician or the hospital. Typically, bills are not sent until all insurance claims have been processed. 

Patients might receive two different bills - a hospital bill and a physician bill - depending on the services they receive. Patients are not billed more than once for the same service.

• McKenzie Health System bills patients for hospital-based procedures and hospital stays including room rate, medical supplies, medication and services performed by hospital personnel
• Your physician bills for services received from the doctor. If you had diagnostic testing done that required a physician to interpret the test, such as radiology services or an EKG, you will receive a separate bill for the physician’s services.

Once a bill is received, patients are given 20 to 30 days to pay their bills in full, depending on the procedure or service. The due date will be noted on your bill. McKenzie Health System can arrange flexible payment options or can provide information related to a loan application from an outside company.

If you have questions about your hospital bill, contact McKenzie Health System at 810-648-3770 and ask for the patient account representative.