Your Rights
Understanding Charges
You have the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known, and you have the right to receive within a reasonable period of time, an explanation of the hospital’s statement of charges for services rendered. Upon request you will be provided with an itemized statement to assist in completing and processing your insurance forms.
Your Right to Confidentiality
You have the right to confidentiality in the handling of your health information except when reporting is required by law.
You have the right to personal privacy as written in the federal regulation, Health Insurance Portability and Accountability Act (HIPAA). We will make reasonable efforts to see that its uses, disclosures, and requests for disclosure of Protected Health Information are limited to the minimum amount necessary to accomplish the billing and collection of your account(s).
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, and/or a deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in- network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at an in-network hospital or ambulatory surgical center, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
Estimate of Charges:
You may ask for an estimate of the amount that you will be charged for a nonemergency medical service provided by a health care facility or practitioner. Indiana law requires a health care provider or facility to provide an estimate for nonemergency services within 5 business days of receiving a request for one.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
-Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the Indiana Department of Insurance at https://www.in.gov./idoi/consumer-services/ or 1-317-232-8582 or visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Your Responsibilities
Your Responsibility to Provide Complete and Accurate Billing Information
It is important that we are provided with complete health insurance information upon registration. This includes presenting a driver’s license or ID, all insurance cards and authorization forms. This information must be provided each time you are registered.
You are responsible for your physician’s order if you are scheduled for outpatient services. If you do not have an order, please be sure your physician has faxed it to the hospital prior to your arrival. Your order must include a diagnosis.
You are responsible for providing information relating to your plan coverage at the time of admission or registration. Please understand and comply with the requirements of your insurance. Know your benefits, and obtain proper authorization for services when required. The HMO, PPO or Medicaid Managed Care plans may require a referral, prior authorization, or certification prior to services being rendered. If you receive a service that is not covered by your insurance, you may be asked to sign an Advance Beneficiary Notice or Letter of Non-Coverage to signify that you have been informed of your payment responsibility.
Your Financial Responsibility
You have the responsibility to meet your financial obligation to the hospital. That responsibility includes the provision of information necessary for filing insurance claims, and cooperation with the hospital when other payment arrangements are necessary.
You must respond promptly to requests you receive from your insurance. While we will attempt to provide all information and paperwork to your insurance, sometimes they require a response from you to resolve issues related to your account or insurance coverage.
Although the Methodist Hospitals maintain an active follow-up program with all insurance carriers, it is the patient’s responsibility to contact their insurance company to ensure prompt payment of their accounts.
Please make timely payments on your portion of the bill. Payment for your hospital bill is ultimately your responsibility. You may be asked to pay at the time of service or prior to discharge if you have a deductible, co-payment, co-insurance or other self-pay amount.
For your convenience, we accept cash, personal checks, money orders, Visa, MasterCard or Discover. Short term interest free payment options are available as well as loans for the longer term payment plans.
Please let us know if you anticipate problems paying your bill. As a not-for-profit organization we are happy to assist those in need. If you are having financial difficulties, please let us know. Financial Services at the hospital can discuss payment alternatives that may be available to you.