Oconee Regional Medical Center

Your Hospital Bill

Your Hospital Bill

[tab:Understanding Your Bill & Insurance Claim]

Understanding Your Hospital Bill and Insurance Claim

Your billing responsibilities: Processing Your Bill With Your Insurance
We ask that you provide us with complete health insurance information upon registration. This includes presenting a driver’s license or ID, all insurance cards and authorization forms. If you have been a patient at ORMC before, we ask that you verify your personal information and insurance at each registration. We will ask you to authorize release of information and assign benefits to the hospital.

Please understand and comply with the requirements of your health plan by knowing your benefits, obtaining prior authorizations for services, submitting claim forms or completing a coordination of benefits form as your health plan may require. Your physician may have ordered tests or procedures that your health plan does not cover. In these cases, check your health policy plan handbook or call the telephone number on your insurance card for more information.

Please respond promptly to requests you receive from your health plan. While we will attempt to provide all information and paperwork to your health plan, sometimes they require a response from you to resolve issues related to your account or insurance coverage. If you health plan has not made payment within 60 days after billing, and has not responded to our attempts to resolve payment matters on your behalf, the balance owed may become your responsibility. Your insurance company will usually send you an explanation of payment they have made to providers on your behalf at the same time they make payment to the provider.

Hospital Bill Frequently Asked Questions
For answers to frequently asked questions about your hospital bill, click the Hospital Bill FAQ tab at the top of the page.

Please call us if you have any questions or concerns about a bill. The best number to call is always the number on the bill you are inquiring about. For your information, we have also listed the most frequently called numbers on the Helpful Numbers tab at the top.

What we will do for you
If you have current insurance coverage, the hospital will bill your insurance carrier shortly after health care services are rendered. When a bill is sent to your insurance company a summary statement is also sent to your attention. Please note this summary is NOT a bill, but an acknowledgement that the hospital has sent a bill to your insurance company on your behalf. As a convenience to you, we will not send another statement until your insurance company has paid and there is a balance due, or unless we have been unable to obtain payment from them. If you have more than one plan, we will bill additional carriers. There are many reasons for claim processing delays through your insurance carrier. Please keep in mind that it could take months before you receive a statement from the hospital showing a balance that you are responsible for paying.

You may call the Business Office Monday through Friday during the hours 8 a.m. to 4:30 p.m. except on holidays. You may occasionally reach voice mail and if you leave a message a representative will call you back within 24 hours.

You will have access to a financial counselor or billing specialist to answer billing questions or assist you with payment issues. They will be able to assist you with questions concerning insurance benefits, hospital charges, payment options and applying for financial assistance.

You will be treated with dignity and respect. At ORMC, all patients will be treated with dignity and respect, regardless of your ability to pay.

You will have access to information on the hospital’s Charity and Financial Assistance Programs. Patients with balances resulting from limited or no insurance coverage may qualify for our charity care or financial assistance programs. These programs are designed to assist patients who are either financially or medically indigent. A financially indigent patient is a person who is uninsured or underinsured and is accepted for care with no obligations or a discounted obligation to pay for services based on income and family size. The hospital uses poverty income guidelines issued by the U. S. Department of Health and Human Services to determine a person’s eligibility for care as a financially indigent patient. ORMC may consider other financial assets and liabilities of the patient to determine ability to pay. The patient is responsible for providing information requested during the qualification process and will continue to receive a bill until eligibility for financial assistance has been determined. Please ask the financial counselor for information about these programs. Click here for a little more on financial assistance.

Thank you for choosing Oconee Regional Medical Center as your health care provider. We understand that hospital bills and health insurance claims can be confusing. With that in mind, we have provided this information to help you better understand billing issues. If you have any questions concerning this information about your bill, please call 478-454-3585, and you will be directed to the person most qualified to answer your questions.

In plain terms, we will try to help you understand what our hospital billing representatives can do to assist you, what you can do to assist us and your health plan, and how we can help you with your application for qualifying for government or other possible financial assistance programs.

[tab:A Word About Doctor’s Bills]

A Word About Doctor’s Bills

Oconee Regional Medical Center hospital bills do not include fees for certain physician services. If your treatment includes the services of radiologist, pathologist, or anesthesiologist, you will receive a separate bill from these physicians. If you have questions regarding any of your physician bills, please call the telephone number printed on your physician bill.

[tab:Tips for Medicare Recipients]

Tips for Medicare Recipients

If you are Medicare-eligible and are scheduled for outpatient services, please have your physician’s orders with you, or be sure your physician has faxed it to the hospital prior to your arrival. This will help prevent delays in the registration process. If Medicare does not cover the services ordered, you may be asked to sign a Medicare Advance Beneficiary Notice (ABN) to signify that you have been informed the payment will be your personal responsibility. Your registrar or a business office representative can answer your questions concerning the ABN.

[tab:Helpful Telephone Numbers]

Helpful Telephone Numbers

Admissions/Outpatient Registration
478-454-3565
478-454-3566
478-454-3567

Radiology Registration
478-457-2874
478-457-2875
478-457-2876

Centralized Scheduling / Precertification Representative
478-454-3588
478-454-3595

Business Office Main Line
478-454-3585

[tab:Managed Care Affiliates]

Managed Care Affiliates

1st MN
Aetna PPO
Aetna Workers Compensation Amerigroup Medicaid HMO Blue Cross Blue Shield PPO
Blue Cross Blue Shield Prudent Buyer
Beech Street
Carolina Care Network
Choice Care
CIGNA
Evercare – Medicare Advantage
First Health
Great West
Healthcare Solutions
Health Star Heartland Hospice
Hospice Care Options
Identity MCO Workers Compensation
Medicare
MultiPlan
Private Health Care System
Preferred Plan
PHP Principle Nova Net Inpatient Only
Provident
Secure Care
Secure Horizons Medicare Advantage
Southcare (aka Principal)
Serenity Hospice
Wellcare Medicaid HMO
United Healthcare

For additional information concerning the hospital’s Managed Care or Insurance Company affiliations, please call 478-454-3698 to speak with our Business Services Director.

[tab:Hospital Bill FAQ]

Hospital Bill FAQ

How do I know if Oconee Regional Medical Center (ORMC) is contracted with my health plan?
To receive full insurance benefits, some health plans require patients to receive services at an “in network” or “participating provider” hospital. Please call your health plan to verify its requirements and to be sure ORMC is in your network.

What managed care organization are affiliated with ORMC?
Click the Managed Care Affiliates tab to view the current list of managed care affiliates.

What if ORMC is “out of network,” can I still go there?
In an emergency you should go to the closest hospital. Your health plan will generally cover these costs or transfer you to an “in-network” hospital if it is safe to do so. If you elect to go to an “out of network” hospital in a non-emergency, you may be required to pay a larger deductible or a greater portion of your bill. There are also plans that provide no payment if you select non-emergency care from an “out of network” provider. Be sure you understand your “out of network” options with your health plan.

How can I be sure my health plan will pay my hospital bills?
Some health plans require a patient to pre-certify certain services, or to notify them within a certain period of time after becoming hospitalized. If your hospitalization is not an emergency, we encourage you to review and understand your insurance card and benefit documents your health plan or employer has provided you. On elective procedures you should talk to your doctor’s office and your health plan about coverage. Please discuss additional concerns with the Admission’s Office or Business Office as soon as possible.

If you have questions about your specific bill please either call the Business Services Office at 478-454-3698 or e-mail your question by clicking here.