What are “out of pocket” expenses?
Your out-of-pocket expenses are established by the terms of your insurance plan and are a combination of your deductible, copayments, and co-insurance:
Copayment: a flat fee that you pay (due at time of service) each time you have a health-related service. For example, you may have to pay $15 for each clinic visit or $25 each time you have a prescription filled.
Deductible: the amount you must pay each year for health-related expenses before your insurance policy or health plan begins paying.
Coinsurance: a percentage of the cost of covered health related services after you have met your deductible. Usually, coinsurance is 20% to 30% of what your health plan approves. Your health plan would pay the remaining 70% to 80%.
If I have more than 1 insurance plan, will you bill those insurance companies also?
Yes. If you have given us information about all your policies, we will bill those insurance companies after your primary insurance company has processed your claim.
How will I know what I am expected to pay for?
It is best to call the customer service phone number listed on your insurance card to ask specific questions about what services and what percentage of charges your plan will pay for. The best time to do this is before you receive care. Here are some questions you should ask:
- Whether Northfield Hospital & Clinics are in network
- Whether your plan includes coverage for the service/care you are considering
- What percentage of charges your plan will pay for
- How much of your deductible remains for you to pay this year in health care costs
You are expected to pay for all charges your insurance plan does not cover.
You will receive a statement from Northfield Hospital & Clinics and are expected to pay within 30 days of receipt of your statement.
What if I am having trouble paying my bills?
We are happy to offer you a variety of payment plan options, all at no interest. We accept Mastercard, Visa and Discover for your convenience. Contact our Patient Financial Services office for assistance at 507-646-1399.
Can I pay my bill online?
Yes, Once inside MyHealth Info, click on the Billing button. Click on the account you wish to pay. Then click on the Make a Payment button to the right of your bill. If you have both hospital and clinic bills, you will need to pay each separately.
To pay a bill for someone other than yourself:
If you have access to their account:
- Click on the Change Person link/button at the top. Then pick the person you wish to pay for.
If you don’t have access to their account:
- To request access to someone else’s account, please fill out the appropriate form.
- MyHealth Sign Up Form
- MyHealth Sign Up Form for Parent/Guardian
- MyHealth Sign Up Form for Adult Proxy/Legal Custodian
Please note: You will not be able to pay your children’s bills on-line once they turn 13 due to federal and state privacy and confidentiality laws. To pay your children’s bill, call 507-646-1399 or 866-465-9005.
HOSPITAL BILLING QUESTIONS
What is included in my hospital bill?
Your bill includes charges for most services you receive at the hospital. However, you will also receive a separate bill from providers who were involved in your care and who are part of their own professional group.
- Consulting Radiology, Ltd. or Center for Diagnostic Imaging for interpretation of x-rays, CT and MRI’s
- Hospital Pathology Associates for examination and interpretation of specimens removed during a procedure or surgery
- Regional Anesthesia for administration and/or oversight of anesthesia and sedation services
- Allina for daily physician visits during inpatient stays, if your primary doctor is a member of the Allina Physician group
- Minneapolis Heart Institute or Mayo Clinic for interpretation of echocardiograms and stress tests
- Mayo Clinic for certain clinic visits
What is a hospital-based clinic?
A hospital-based clinic is a clinic that is owned and operated by a hospital. It is common for health care systems to operate hospital-based clinics. The services are billed as a hospital out-patient service when claims are submitted to Insurance companies.
Does Northfield Hospital & Clinics have any hospital based clinics?
Yes, the Center for Sports Medicine & Rehabilitation, Cancer Care & Infusion Center, Breast Care Center, Stress Testing, Fluoroscopy Injection Clinic and Endoscopy Center are all hospital based clinics.
Will I pay more for services provided at a hospital-based clinic?
Each patient’s insurance plan is unique. Your insurance plan may cover the services differently for a hospital-based clinic, which could impact your out of pocket expenses. We recommend that you review your insurance benefits and/or contact your insurance provider to determine what your policy covers. This will help you determine ahead of time what you may be expected to pay for those services provided.
What questions should I ask my insurance provider?
Ask whether or not they cover facility charges in a “Hospital-Based Outpatient” or “Provider-Based” location. If they do provide coverage, ask how much of the charge is covered or if it will be applied to your deductible. You can also verify any co-pay responsibilities you may have as well.
CLINIC BILLING QUESTIONS
How does my insurance company know what services I receive during my exam/visit?
Each service a patient receives during an office visit is identified by a code.
- The International Classification of Diseases (ICD-10) codes, defined by the World Health Organization, are used to identify a patient’s diagnosis.
- Current Procedural Terminology (CPT) codes, defined by the American Medical Association, are used to describe any procedures that were performed during a patient’s visit.
Your billing statement will reflect any remaining balance your insurance plan has identified as patient responsibility. If you have questions regarding your billing statement, please contact our Patient Financial Services office at 507-646-1399.
May I request a change in the coding for services provided?
Coding must reflect what happens during your medical visit and match what is recorded in your medical record. Federal law requires appropriate and accurate coding. Sometimes a patient believes or is told that if a different code had been used, he/she would have coverage for a specific procedure. However, it is fraudulent and illegal to change codes solely to obtain reimbursement. It is very important to understand your specific insurance coverage, in advance, so that you will not be surprised if a specific service is not covered by your policy.
How will I be charged if I have a routine exam and also need to discuss a new problem during the same visit?
We will submit a charge for each service to your insurance company.
Will my insurance company pay for both services during the same visit?
This depends on your individual insurance policy.
- Medicare does not cover “routine exams”
- Some insurance policies will require that you pay two co-pays
It is your responsibility to check with your insurance plan to determine what they will cover.
Why does my bill describe my visit as a “level”?
Levels of service describe the complexity of the visit, the nature of the patient’s individual condition, paperwork requirements and the type of exam and counseling. Charges are based on the level of service provided, rather than the amount of time you spend with your provider.
For example, a simple “nurse only” visit for a blood pressure check would likely be a level 1. However, a physician visit to address and manage multiple chronic conditions might be a level 5.
Charges may vary depending on whether you are new to our clinic or specialty. Below is an example of the range of charges (for levels 1-5) that we submit to insurance companies.
- New patient $101 - $483
- Established patient $47 - $337
*These prices are subject to change.
Why am I getting a hospital bill if I was never admitted to the hospital?
This is because you received a “hospital-based” service, such as a lab or x-ray during your visit. Government regulations require that we send a separate hospital bill for those services.
What are diagnostic services?
Diagnostic services are those that evaluate specific symptoms or manage an existing disease. Sometimes a service begins as a screening exam, but becomes a diagnostic exam when a significant problem is found or if identified by the patient during the exam that may require treatment. An example would be a screening mammogram in which the patient identifies a specific area of concern; the mammogram is then coded as a diagnostic exam. Also a colonoscopy that starts out as screening may end up being coded as diagnostic if there are findings or biopsies done as a result of that procedure.
Does insurance cover diagnostic services?
Insurance coverage for diagnostic services varies among insurers. Coverage for some medical services may require preapproval from your insurer. It is important to check your policy and address questions, in advance, with your insurer. Generally, Medicare pays for diagnostic services. Medicare limits payment for some medical services, and you may be responsible for payment of non-covered services.
What are preventive services?
Preventive (also referred to as screening) services are designated to detect an undiagnosed disease when the patient has no signs or symptoms. Preventive services include physical examinations for patients who don’t have specific health problems, cancer screening tests, bone mass measurements, and others.
What is included in a preventive exam?
Included: A physical exam, screening for physical and mental health problems, a discussion of health risks related to your life style, your health history, your family’s health history, and advice about obtaining preventive screening options appropriate for your age, gender, and health risk. These may include things like mammogram, colonoscopy, eye exam, etc.
Not included: Assessment or treatment of a medical problem or chronic problem.
Does Insurance cover preventive services?
Insurance coverage for preventive services varies among insurers and on whether the findings of diagnostic tests are normal or abnormal. It is important to check your insurance policy for a list of preventive services covered and not covered and also to consider any time limitations required to obtain a preventive service. Some insurers may require a specific time period to elapse before repeating a preventive medical service. Address coverage questions with your insurer. It is best to make certain, in advance, whether you have coverage for a service. Medicare provides limited coverage for preventive services.
What preventive services does Medicare cover?
Medicare covers the following services on a periodic basis, but the percent of coverage will vary for certain tests depending on whether the findings are normal or abnormal:
- Tests for breast cancer, cervical cancer, vaginal cancer, and colorectal cancer
- Bone mass measurements
- Flu, pneumonia, and Hepatitis B shots
- Prostate cancer screening, including digital rectal exam and Prostate Specific Antigen (PSA) test
For further information on Medicare coverage available, visit http://www.medicare.gov/publications and select the “Medicare and You” link.
What is a Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit is a discussion of your risk factors. It is not a complete physical exam and does NOT replace your annual physical exam with your regular health care provider each year. It is an annual visit that Medicare will pay in full.
There are strict guidelines set by Medicare that we must follow for the Medicare Annual Wellness visit. Only the following items will be included in that visit:
- Review of your medical and family history
- Assessment of your functional ability and level of safety at home
- Potential risks, especially for depression and other mood disorders
- Height, weight, and body mass index
- Blood pressure
If you have other health concerns, such as diabetes, heart disease, high blood pressure, abdominal pain, headaches, or back pain, these will NOT be covered by the Medicare Annual Wellness Visit benefit. If you and your health care provider decide to address your other health concerns at this appointment, you may be responsible for any deductible, co-pays, or co-insurance that may occur from the additional charges.
A complete physical exam is NOT a covered preventive benefit under Medicare. If you have a Medicare Supplement policy, you may have coverage for this service. Check with your insurance company regarding your benefits prior to your appointment.