About Your Bill
Your Medical Center Bill
When you return home from your hospital stay with us, you will receive separate bills for specific services provided. The hospital bill includes charges for your room, food, medical supplies, and any tests or procedures performed. Your doctors may send additional bills for their medical and surgical care.
The hospital bill covers the cost of your room, meals, 24–hour nursing care, lab work, tests, medication, therapy, and the services of hospital employees.
Our Patient Financial Services Department will file your claim directly with your primary and secondary insurance provider. You are responsible for the charges for your stay in the hospital. If you do not receive a notice of payment from your insurer within 60 days of receiving a copy of your hospital bill, we recommend that you contact the insurer directly and encourage speedy payment.
If you are covered by Medicare, we will submit your claims to Medicare on your behalf. After Medicare makes its payment, we will bill your supplemental insurance carrier for the remaining balance. If you do not have supplemental insurance, you will be responsible for the balance.
We will need a copy of your Medi–Cal Beneficiary Identification (BIC) to verify eligibility and process your Medi–Cal claim. You should be aware that the Medi–Cal program excludes payments for restricted services. Any applicable share of cost are also the responsibility of the patient.
You May Receive More than One Bill
When you receive medical care from one of our Providence locations, you may receive more than one statement for the treatment received during your visit. Many services must be divided between provider (MD, DO, PA, ARNP, NP, etc) and the supplies and/or staff resources used in order to meet federal and state billing regulations. This may result in two separate billings for a single date of service, which may also lead to two explanations of benefits from your payor and/or two statements forwarded to you for services.
Common examples are:
- Inpatient hospital facility and doctor's services
- Outpatient hospital x–ray and a radiologist reading
- Emergency room facility and the ER doctor's service
- Doctor's visit with lab and/or x–ray services
Outpatient clinic types
The most common types of doctor visits provided in outpatient clinics are:
- Free–standing, which includes the doctor, staff and supplies on one bill.
- Provider–based clinic and Outpatient Hospital Departments, which divide the doctor from the supplies and staff. In some cases, the charges may be more in a provider–based clinic due to the hospital resource expense. Additional Providence services which may be billed on a separate statement from your doctor visit, emergency room service, inpatient and/or outpatient hospital services include: Anesthesia, ambulatory surgical center, birthing center, durable medical equipment, home health, hospice, laboratory & pathology services, nursing facility, nutrition therapy, occupational therapy, operating room services, physical therapy, specialty physician services, rehabilitation, x–ray procedures, etc.
Generally, you will receive a bill one to three weeks after you receive services from the physicians of Providence Health & Services. If you have health insurance, our billing office will first bill your insurance carrier for all services. If your insurance plan does not cover a service or procedure or does not cover the entire cost, you will be responsible for the uncovered fees.
Please keep each statement separate. Do not combine your statements and submit one payment. Pay each office separately.
We accept American Express, Discover Card, MasterCard and Visa as well as personal check, cashier's check and money order.
You can request information about the estimated charges of your hospital or professional services. Please do not hesitate to ask for information. The actual charge may be more or less than the estimate depending on the type and extent of care that you and your provider determine is needed. All of our usual and customary charges for our services are contained in our "charge master." Your charges will depend on the actual services rendered, not on the estimate.
Providence Medical Centers are contracted with most major health plans, including HMOs, PPOs, EPOs, PPS, Medicare and Medi–Cal. Please contact your health plan for verification of coverage.
All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the hospital's billing procedures and charges. If there is a question about your insurance coverage, a member of the Admitting Department will contact you or a family member while you are at the hospital.
Proof of health insurance
We will need a copy of your identification card. We also may need the insurance forms, which are supplied by your employer or the insurance company.
HMO or PPO members
Your plan may have special requirements, such as second surgical opinion, pre–certification or authorization prior to certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan's requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered.
We will need a copy of your Medicare card to verify eligibility and process your Medicare claim. You should be aware that Medicare program specifically excludes payment for certain times and services, such as but not limited to self–administered drugs, cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others. Deductibles and co–payments also are responsibility of the patient.
Medi–Cal is California's Medicaid program, a medical assistance program for low–income residents funded by the state and federal government. If you are covered under this program, please provide an eligibility card or other proof of eligibility for each month of service.
If you do not have insurance or if you are seeking care that's not covered by your insurance plan, you are considered a self–pay patient. Payment is required within 30 days of billing.