Billing and Financial Assistance

Baptist Health’s goal is to provide non-emergent patients with as much information about the price of a service as possible. If you would like to obtain information about the price of a service prior to scheduling the service, you may do so through Baptist Health’s Central Pricing Office.

When the service prescribed by your physician is scheduled at a Baptist Health facility, your health insurance information will be requested. If you are uninsured, a patient financial representative will contact you to provide a discounted, self-pay price and information about financial assistance.

If you have health insurance, the insurance coverage provided at the time of scheduling will be verified with the insurance company. In addition, your patient responsibility (copay, unmet deductible, coinsurance) for the scheduled service will be obtained from the insurance company. A patient financial representative will contact you to finalize needed information and communicate your out-of-pocket financial responsibility. Payment may be made via credit card at this time to make the check-in process on the date of service more efficient.

When you consent to receive treatment at a Baptist Health facility, a guarantee of payment and assignment of insurance benefits are made. The assignment of insurance benefits allows Baptist Health to bill your insurer on your behalf. However, if the insurance company ultimately does not pay for the service, you remain financially responsible. Baptist Health will make a diligent effort to confirm that a scheduled service is covered by a your insurance, but this is ultimately the patient’s responsibility.

The scheduled service may need pre-approval (often called pre-authorization or prior authorization) from your health plan before the service takes place. Through the pre-approval process, the health plan will confirm coverage and medical necessity – in other words, that the service is covered and appropriate for your condition.

As a healthcare consumer, it is important to understand which services require pre-approval. If you receive care without first obtaining a required pre-approval, the health plan may not cover the claims for your care. Pre-approval may be required for a variety of services, such as CT or MRI scans, surgery and even labs. When in doubt, call your health plan to find out whether pre-approval is needed. If your health plan requires pre-approval for a particular service, contact your physician to ensure that the pre-approval has been obtained.

When you arrive for a scheduled service, certain information will be confirmed and consent documents will be signed. A patient financial representative will then collect your out-of-pocket responsibility (copay, unmet deductible and coinsurance). Payment in full is due at the time of service. Arrangements to be billed may be granted in exceptional circumstances based upon established criteria. If the patient responsibility (or approved portion thereof) is not paid at the time of service, the service will be rescheduled. If the full patient responsibility is not collected at the time of service, you will be billed for the remaining balance after the insurance payment is received.

After you receive services, Baptist Health will bill your insurance company. Any patient responsibility reported by the insurance company that was not collected at the time of service will be billed to you. Unfortunately, payment by the insurance company is not always received quickly or easily. See additional discussion of the patient’s responsibilities to participate in the collection process under all services below.

A federal law known as EMTALA (the Emergency Medical Treatment and Active Labor Act) gives everyone the right to be treated for an emergency medical condition, regardless of their ability to pay. This law helps protect patients who are uninsured as well as those who have Medicare, Medicaid, or private insurance.

It is important to realize that having a right to emergency care does not mean the care is free. The Baptist Health hospitals’ policies for billing, payment, and eligibility or financial assistance still apply. Upon patient request, financial coverage for the service will be discussed after you have received a medical screening examination in the emergency department (ED) or urgent care (UC). If you have insurance, you will be asked to pay the copay and/or unmet deductible for emergency or urgent care as verified with your insurance company. Following discharge, Baptist Health will bill your insurance company. Any patient responsibility reported by the insurance company that was not collected at the time of service will be billed to you. Unfortunately, payment by the insurance company is not always received quickly or easily. See additional discussion on the patient’s responsibilities to participate in the collection process under all services below.

Uninsured patients will receive information about Medicaid or other government programs and the hospital’s financial assistance program. This information may be provided after the medical screening examination or after discharge through the mail or a phone call. If an uninsured patient is able to meet with a financial counselor at the hospital and determined to be ineligible for Medicaid or financial assistance, the patient will be asked to make a payment toward the emergency or urgent care provided.

Despite appropriate pre-service procedures, sometimes insurance companies do not pay. Since patients are financially responsible for the service, even if the insurance company does not pay, patients need to proactively participate in the insurance collection effort. You may be requested to participate in the following ways:

• Completing and signing a coordination of benefits form. This is a form sent to a patient by the insurance company to confirm that there is no other insurer which should be responsible for the claim. It is essential that patients complete and sign these forms and return them to the insurance company immediately.
• Researching and appealing denied claims. Often patients have greater success communicating and resolving claim denials than the hospital or other providers do. You pay premiums for your insurance benefits and deserve to be able to rely on those benefits.
• Coordinating with the referring physician or surgeon to write a letter of medical necessity. Occasionally, even though an insurer pre-approved a service or stated that no pre-approval was needed, payment of the claim will be denied due to a lack of medical necessity (i.e. the insurance company concludes the service was not necessary for the medical condition). In this case, a letter from your physician is often needed to demonstrate why the service was appropriate and necessary to address your condition.

Patient balances determined and reported to Baptist Health by a patient’s insurance company and not collected at the time of service, will be billed to the patient. A series of letters and statements will be sent to the patient at the address provided during registration. Uninsured patients will be reminded of the opportunity to apply for financial assistance. Past due patient balances may be referred to a collection agency for collection.

Patients will be provided with sufficient notice and opportunities to pay or establish an acceptable payment arrangement prior to any extraordinary collection actions. Extraordinary collection actions are any action that require legal or judicial process including but not limited to: placement of a lien on an individual’s property, foreclosure on an individual’s real property, attachment or seizure of an individual’s bank account or other personal property, commencement of a civil action against an individual, causing an individual’s arrest or writ of body attachment, garnishment of wages, reporting adverse information about individual to a consumer credit reporting agency and sale of an individual’s debt to another party.

The patient billing and collection processes described above are for the use of the hospital or other health care facilities. Emergency, urgent care and other physicians that are not employed by the Baptist Health hospitals and facilities provide services in those settings. These caregivers bill separately from the hospital/facility and may or may not participate with the same health insurers or HMOs as the hospital/facility.

If you have other questions about your bill, please consult the Frequently Asked Questions resource. If the Frequently Asked Questions resource does not answer your question, you may contact Customer Service on weekdays from 9am to 4:30pm at 786-596-6507 or 1-800-235-0065 (local number for Mariners Hospital is 305-434-3033).