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Proof of coverage
At the time of registration, you will be asked to provide either your current insurance company card or information about your current insurance company. In addition, please furnish any specific forms or original documentation (claim forms, authorizations, referrals, etc.) required by your insurance company.
Mercy will bill your insurance carrier if you have provided us with all necessary policy information. In the absence of necessary billing information, you will be responsible for payment of your entire account.
During the registration process, you will be asked to sign an Assignment of Insurance Benefits form. This form allows Mercy to file your medical claim with your insurance carrier and have your carrier make payments directly to Mercy. Please read this form carefully. The registration staff will be happy to answer any questions regarding its content. Mercy files your insurance claim as a courtesy service. However, you are ultimately responsible for paying for the services provided.
Many insurance plans have pre-certification requirements. Generally, you or your physician is responsible for obtaining pre-certification. Most insurance companies will not accept pre-certifications from the hospital.
To avoid penalties or reduction of payments, for which you will be responsible, call your insurance carrier or employer for specific information.
Insurance companies do not pay for all medical services, even those that might be helpful to a patient. When a service is not covered by your insurance policy, you are responsible for paying the bill. Physicians dictate your diagnosis for each visit or procedure. We are unable to change this information just so the claim will be paid.
During registration, Medicare recipients will receive a form entitled “An Important Message from Medicare.” This form provides important information and telephone numbers that may be needed by our Medicare patients. Mercy will bill Medicare on your behalf for services rendered. You are always responsible for any applicable deductibles, co-payments, or other amounts not paid by Medicare. For your convenience, we will also bill your supplemental carrier for any balances following Medicare’s payment.
We require all Medicaid patients to present a current eligibility card at the time of registration. Without verification of your coverage, you will be responsible for your account. We will bill your account to Medicaid when all necessary information has been provided. You are responsible for non-covered portions and spend-down requirements associated with your individual coverage.
If you have been injured in some manner, whether through an automobile accident, fall, etc., Mercy will bill your health insurance first, then the liability carrier you specify for any deductible or co-payments your health insurance did not pay. Although another party may have some legal responsibility for your injuries, this matter is between you, your attorney and the party responsible for the injury. If you are a Medicare or Medicaid recipient, health care laws require that we bill the liability carrier first, then Medicare or Medicaid.
Our fees are accepted by most insurance plans as “usual, customary and reasonable.” We do not make UCR reductions unless we have a contractual arrangement with your insurance company.
Most insurance companies routinely audit some of their claims. If your insurance company selects your claim for audit, you may experience a delay in your claim being paid. Mercy will provide your insurance company with any detailed information they might need to complete their audit. However, Mercy has no control on the length of time the insurance company takes to complete the audit. In the event that your insurance carrier is not prompt in making payments, Mercy will need your assistance in contacting your carrier for payment. Insurance carriers are more responsive to patient inquires than to ours.
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