Billing & Medicare FAQ

Insurance

Medicare


Insurance

Should I bring my insurance card with me to the hospital?
Yes, the information on your insurance card is needed for the hospital to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign a few forms. This registration process goes much faster when you bring your insurance information with you.

Do I need to let my insurance company know that I'm going to be in the hospital? What will they cover?
We encourage you to check with your insurance company or your employer about this. Because there are so many types of insurance plans, it is difficult for us to tell you whether or not you need prior approval or notification for your hospital stay. Contact your insurance company or your employer with specific questions about what is or is not covered by your insurance plan.

How do I know if my insurance company will cover my visit or certain services?
Coverage varies with each insurance company. Generally, the hospital staff does not know whether a particular service will be covered. Medically necessary and appropriate services may not always be covered by your insurance contract. Please refer to your insurance member handbook or call your insurance company with questions.

How do I know if my insurance company will cover services provided by all professionals (i.e. anesthesiologists, radiologists and pathologists) involved with my treatment?
We encourage you to check with your insurance company or your employer about this. Each professional needs to contract individually with insurance companies and the hospital does not know if each professional is contracted with your insurance company.

Will you bill my insurance company for me?
Yes, as a courtesy we will bill your insurance company. It is your responsibility to provide any requested information to your insurance company (accident information, claim forms).

How will I know if my insurance company has paid my bill?
If there is a balance due from you after the insurance company has paid its portion, we will send you a statement. This statement indicates the amount that has been paid and any balance you are required to pay. This is your bill. You are required to pay this bill in full or will need to contact our office.

How do I follow up with my insurance company?
Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Obtain satisfactory status of account. If paid, ask when and to whom. Note this information and with whom you spoke to at the insurance company. If the bill has not been paid, find out when the anticipated payment date is and ask if they need anything from you. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor.

What do I do if I disagree with how much my insurance company has paid on my bill?
If you disagree with the insurance company's payment amount, contact the insurance company and ask them to review how the claim was processed. If the insurance company finds that an error was made, note the information and whom you talked to at the insurance company. Request an anticipated payment date and ask if they need anything from you. If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an "appeal" with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration.

Will I be required to pay anything when I arrive at the hospital?
Upon admission, you will be required to pay the difference, if any, between your verified insurance benefits and the estimated charges for your stay. This amount is based on the average of actual daily hospital charges for patients admitted with similar diagnoses, multiplied by the number of days you are expected to be in the hospital. Your actual charges may be more or less than the estimate. If they are less, you will receive a refund. The deposit does not include your physician's charges or those of other consulting physicians. Those costs will be billed to you directly, once you have returned home.

Does Shands Starke accept my insurance?
Insurance acceptance varies from physician to physician in our outpatient practices. To find out if a specific physician will accept your insurance, you may contact the Shands Starke Consultation Center at (800) 749-7424 or locally at (352) 265-8000 and press 1 when prompted. A service representative will be happy to assist you.

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Medicare

How much will Medicare or Medicaid pay?
Medicare and Medicaid will pay for hospital services. You will be responsible for the co-payment. If you belong to a Medicaid Managed Care Plan or if you signed over your Medicare benefits to a managed care plan, you may need an authorization to see a UF physician or receive hospital services. Visit our Insurance information online to find out more specific information.

Why do I have to give you information about other insurance if I have Medicare coverage?
Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill Medicare. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. In certain situations, the hospital must consider the possibility that another party may be responsible for your expenses before we bill Medicare. For example, if you were injured in a car accident, at your work site or on someone else's property, it is the hospital's responsibility to make sure those claims are filed appropriately. Consequently, we need to have complete information about all insurance coverage you have.

Do I have to sign any forms before Shands can bill Medicare?
You will be asked to sign a Consent for Treatment form each time you receive services. You will also be asked questions each time you receive services that Medicare requires we ask.

You may contact GHI/COB Customer Service Center at (800) 999-1118 to update your common working files master files.

I have health insurance in addition to Medicare coverage. Will you bill that insurance company also?
If you have given us information about your additional health insurance, we will bill that insurance company after Medicare makes their payment.

What is the Medicare Explanation of Benefits form?
The Explanation of Benefits form is an information document that Medicare sends to you after it has processed your medical claims. The Explanation of Benefits form provides you with information about the payment status of your bill.

What is the difference between Part A and Part B Explanation of Benefits forms?
Part A covers inpatient hospitalization and Part B covers outpatient and physician services.

What should I do with the Explanation of Benefits forms?
We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the Explanation of Benefits from you before they will pay any remaining balance on your account.

Should I pay the balance that is listed as "your total responsibility" on the Explanation of Benefits form?
No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from your medical provider before making payment.

Will I have to pay any money for my hospital visits?
As a Medicare patient, you will only be responsible for non-covered charges, co-pays and deductible amounts. These amounts may vary depending on your Medicare coverage. We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know your responsibility, we will bill your other health insurance company (if you have coverage) for the balance. If you do not have other health insurance, you will be billed for the balance.

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