Patient Billing and Insurance Claims
- Your insurance policy is an agreement between you and your insurance carrier. Know your insurance plan, each insurance plan differs in what it covers, its limits of coverage and rules that apply to the plan.
- EMHS will bill your insurance company on your behalf. We will bill additional insurance payors if you have more than one. In order for us to do this you must provide us with all coverage information.
- If your claim is rejected or only partially paid the fees may be your responsibility.
- You will receive monthly statements from EMHS showing the current balance due from you.
- You will have access to our billing and credit office personnel who can answer your questions about billing and payment issues.
- If we do not participate with your insurance plan, payment is expected at the time of service.
- We will find help with translation if necessary.
Some insurance carriers require you to go to “in-network” or “participating providers”. Please contact your insurance company to verify the facility and/or physician is currently participating in your plan. A physician may be participating but a facility may not be or vice-versa.
Physicians at EMHS are independent practitioners; participation and acceptance in insurance plans may vary by practice.
Most physicians participate in:
- AETNA/US Healthcare
- Blue Cross of Northeast PA
- Blue Cross/Blue Shield of Central NY
- Blue Shield Premier Blue/Access Care II
- Empire Blue Cross/Blue Shield
- First Priority/CHIPS
- GHI-(Multi Plan)
- Keystone Mercy Health Plan
Please provide us with your complete health insurance information when you register.
Have your current benefit card at the time of registration.
Please know the requirements and benefits of your insurance coverage.
Submit referral or claim forms.
Make your co-payments, deductibles, or other self-pay amounts at time of service.
The physician may order tests or procedures that your insurance company does not cover.
Please respond promptly to requests from your insurance company – We provide all available information and paperwork to your insurance company, however sometimes insurance carriers require a response from you related to your account. Lack of response may affect your coverage and the balance due EMHS will become your responsibility.
Please make timely payments on your portion of the bill. At the time of service you will be asked to make co-payment, deductibles, or other self-pay amounts due. For your convenience EMHS accepts cash, personal checks, money orders and certain credit cards. Interest-free payment options can be arranged by the Credit Department to those that qualify.
Please do NOT send any credit card information through this site. The EMHS web site is not a secure site. For credit card payments contact: Credit Office & Collections ext. 284.
Please let us know if you are having financial problems. The Credit Department can discuss options that may be available to you for making payment.
- Extended payments
- Government programs
- Charity care
We require personal and financial information when you apply for any of these programs.
Being a non-profit organization, EMHS provides medically necessary care to community members regardless of their ability to pay. Using the Federal Poverty Guidelines (FPG) as a guide, and financial information provided with the Charitable Care application, EMHS considers the following in determining an individual’s ability to pay for health care services:
- patient/family income
- number of dependents
- other individual circumstances
Contact the Credit Office for a Charitable Care application.
For individuals not covered by health insurance and who do not qualify for charitable care, EMHS will work with you to make payment arrangements that are fair and reasonable. Discounts for services may also be provided. Please contact the Credit Office.
Frequently Asked Questions
Why am I getting a bill for services that were provided so long ago?
Once we have received a response from your insurance carrier, if we confirm that there is patient liability, we will bill the patient. Also, insurance carriers sometime require additional information which delays the processing of your claim.
Why wasn’t my insurance carrier billed?
If the information in our billing system is inaccurate at the time of service we will be unable to bill your insurance carrier. Please provide us with your Health Insurance information every time you register.
Did my insurance carrier pay for services?
Reimbursement from your insurance carrier will be reflected on your statement. Some carriers send “explanation of benefits” (EOB) explaining how the medical claim was processed:
- Information on what was paid
- Any non-covered, deductible, or denied amounts
- The balance owed by you
Why didn’t my insurance carrier pay for the services?
Contact your insurance carrier directly for an explanation of how your claim was processed or denied.
Severity of illness / Length of stay
Patients with the same diagnosis may have complications, more than one disorder or disease, or other related difficulties. Severely ill patients and the elderly may not respond as well to treatment or surgery; other factors such as older patients who require more services or who may have chronic or multiple conditions will cause an extended length of stay. The difference in level of care and services cause variations in charges and longer length of stays. Typically, the longer length of stay the higher the charges.
Education, training and experience vary considerably between physicians. Charges may be generated by more than one physician when another physician is involved in consulting roles. Individual physician judgment based on patient needs influence treatment decisions. The kinds of diagnostic tests ordered or treatment preferred by individual physicians also influence charges. Discuss options for testing with your physician as there may be several alternatives that can be used.
Surgeon and anesthesiologist charges are billed separately on EMHS bills. Professional fees that will be charged separately from an outside billing source are radiologist fees: services for reading x-rays, mammos…, pathologist, gynecology, urology and cardiologist services.