Patients with Private Insurance
St. Luke's will submit bills to your insurance carrier to help you receive the full benefit of your health insurance plan. During registration, St. Luke's will obtain information to assist with accurate and timely billing. A copy of your insurance card is needed to process your claim.
Your insurance policy is a contract between you and your insurance company. You should be familiar with the terms of your healthcare plan. Most plans do not provide 100% coverage for your hospital bill. You are responsible for copayments, coinsurance, deductibles, and other charges not covered by your insurance plan. Most plans detail exclusions, services not covered, and plan maximums - please refer to your insurance plan document for specific details regarding what is covered and not covered under your insurance plan.
Most insurance companies issue the patient and the provider of service an explanation of benefits when the provider files an insurance claim for services rendered. The explanation of benefits details the services rendered, information on how the claim was processed and paid by the insurance company, and the patient share due to the provider, if applicable. After St. Luke's receives insurance payment for the claim, St. Luke's begins billing the patient and/or guarantor for any patient share due.
If you have questions about the patient share assessed on your account by your insurance company, or the level of benefits paid, you may contact your insurance company via telephone or internet. You may also contact St. Luke's Customer Service department for assistance.
Two of the most common types of managed care plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
If you are covered by an HMO, a PPO, or another type of managed care insurance plan, your plan may have special requirements, such as pre-certification or pre-authorization for certain procedures. Each healthcare plan has its own set of rules, participating physicians and hospitals, radiology centers, and laboratories. It is your responsibility to ensure your plan's requirements are met in order to receive maximum reimbursement.
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