Billing: What a Hospital Bill Covers
The hospital bill covers the cost of your room, meals, 24-hour nursing care, laboratory work, tests, medication, therapy and the services of hospital employees. You will receive a separate bill from your physicians for their professional services. If you have questions about these separate bills, please call the number printed on each statement.
The hospital is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. You should remember that your policy is a contract between you and your insurance company and that you have the final responsibility for payment of your hospital bill.
Most insurance plans now require pre-certification for hospital stays and certain tests and procedures in order for you to be eligible for full policy benefits. It is your responsibility to see that this is completed. This information can be found on your insurance card. If you are unsure of your pre-certification requirements, we recommend that you contact your insurance company as soon as possible.
Coordination of Benefits (COB)
Coordination of Benefits, referred to as COB, is a term used by insurance companies when you are covered under two or more insurance policies. This usually happens when both husband and wife are listed on each others insurance policies, when both parents carry their children on their individual policies, or when there is eligibility under two federal programs. This also can occur when you are involved in a motor vehicle accident and have medical insurance and automobile insurance.
Most insurance companies have COB provisions that determine who is the primary payer when medical expenses are incurred. This prevents duplicate payments. COB priority must be identified at admission in order to comply with insurance guidelines. Your insurance may request a completed COB form before paying a claim and every attempt will be made to notify you if this occurs. The hospital cannot provide this information to your insurance company. You must resolve this issue with your insurance carrier in order for the claim to be paid.
As a service to our customers, we will forward a claim to your commercial insurance carrier based on the information you provide at the time of registration. It is very important for you to provide all related information such as policy number, group number and the correct mailing address for your insurance company.
If You Have No Insurance
A representative of the Business Office will discuss financial arrangements with you. You may also speak
with a hospital representative from the Social Services Department to assist you in applying for Medicaid or other government-assisted programs. Please let your nurse know if you wish to speak with one of our representatives.
We will need a copy of your Medicare card to verify eligibility and to process your claim. 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. Deductibles and co-payments are the patient’s responsibility.
We will need a copy of your Medicaid card. Medicaid has payment limitations on a number of services and items. Medicaid does not
pay for the cost of a private room unless medically necessary.
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What are Medicare self-administered drugs?
Generally, the oral and topical prescriptions and over-the-counter drugs you get in an outpatient setting like an emergency department, outpatient department, or observation room (even if you stay overnight) are identified as “self-administered drugs” by Medicare and aren’t covered by Medicare Part B. You will likely need to pay out-of-pocket for these drugs and submit a claim to your drug plan for reimbursement. If you have Medicare Part D, call your Part D plan provider for more information.
Why am I being billed for Medicare Part B if I was admitted and stayed overnight in the hospital?
Being “admitted” overnight to a hospital does not necessarily mean you met Medicare inpatient criteria, as set forth in the federal Medicare regulations. Even though you may have stayed one or more nights in the hospital, that stay may not meet inpatient level of care standards, as defined by Medicare. This is typically classified as an “observation” stay. When that occurs, it still falls under Medicare Part B requirements.
Why do I have to pay for these medications?
As detailed in your Medicare Handbook, which is provided to you each year, Medicare does not cover certain medications given in an outpatient setting (including observation).
What happens to medication ordered by a doctor that is not taken by the patient?
If medication is ordered but for some reason is not administered to the patient, the patient is not charged.
Why can’t patients bring their own prescription medications to the hospital?
To ensure patient safety, FGH does not allow patients to bring medication from home unless the hospital pharmacy cannot provide the medication. By law, each medication brought in by a patient must be identified by a hospital pharmacist and visually evaluated for integrity before it could be administered in a hospital.