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Billing & Insurance Frequently Asked Questions

If your question is not covered on this page, you may also want to view Understanding Your Bill, Glossary of Insurance Terms or contact us using the phone numbers listed under Billing Contacts.

General Questions

Why am I required to show my insurance card at every visit?
Insurance plan benefits, eligibility and billing addresses change frequently, so some carriers require us to verify your insurance each time you visit. Checking your card only takes a minute, and it can ensure accurate and timely billing. 

What if I don’t have insurance?

MidMichigan provides financial aid to patients based on their income, assets, and needs. In addition, we may be able to help you get free or low-cost health insurance or work with you to arrange a manageable payment plan. If you believe you will have trouble paying your bill, please contact our financial counseling office at (989) 633-5200, or toll free at (800) 839-6762. 

What does my insurance cover?
Your best source of information about your specific coverage is your insurance company or your employer if you are covered through work. Although you may have health insurance, you have final responsibility for your bills.  

When do I need to get authorization from my health plan provider prior to receiving services?
Depending on your insurance plan, you may be required to get authorization from your insurance company or your primary care physician before receiving services such as emergency room care, physical therapy, referrals to specialists, hospital admissions, urgent care or medical equipment and supplies. If you do not obtain proper authorization, all charges could become your responsibility. Check with your health insurance provider to find out the requirements of your particular plan. 
 
What is an advanced beneficiary notice? 
An advanced beneficiary notice (ABN) is a form that lets you know that Medicare may refuse to pay for a procedure or test - even though your health care provider feels it is necessary in order to offer you the best care. This only relates to patients covered by Medicare.

The ABN helps you make an informed decision about whether to obtain the service and pay for it yourself or choose not to receive the service. For answers to more questions about ABNs, please view our brochure, "Medicare Requires Advanced Beneficiary Notice." 
 
Why do I sometimes see multiple line items on my bill after a regular doctor visit? And why does my insurance company label some of the charges as "preventive" and expect me to pay this portion?
During the course of your preventive health exam, your provider may also discover, investigate, and/or treat any illnesses or other irregular conditions you might be experiencing. Correct coding guidelines require providers to code and charge for each service separately. However, insurance carriers differ in their interpretation of this, and many do not provide a benefit for both preventive care and illness care when provided during the same visit.

Most insurance companies will only provide a benefit for one annual physical per enrollee per year, and some do not provide any benefit for preventive care. To avoid unexpected out-of-pocket medical expenses, we encourage you to verify your insurance benefits before scheduling any preventive care services.
 

Why are you not billing my health insurance for this auto accident?
In most cases, health insurances have an exclusion not to pay primary on auto accident claims. You should contact your insurance to see if this exclusion applies to your coverage.

 

How long do I have to pay off my balance?
Your bill is due upon receipt. If you are not able to pay in full, please contact our Customer Service department to make arrangements by telephone, or you may wish to come in personally and see a Financial Counselor. We have different options for payments depending on each individual circumstance. 

Children

 

Who can authorize medical treatment for my minor child if I am not available?
We offer a consent form for medical treatment of a minor child. You may print this form and use it to delegate authorization to people such as babysitters, relatives, sports coaches or school chaperones who may be taking care of your child in your absence.

 

My 18-year old child is covered on my insurance plan, and I am paying the bills. Why won't you tell me the details behind these bills when I call?
By law, we must protect the confidentiality of health information for anyone 18 or older. If you need more details about your child's diagnosis or treatment in order to understand a bill you have received, you will need to ask your child to contact us for this information.

Home Care

What does it mean when my statement says, "Please contact our office?"
This means we are requesting additional information in order to properly bill your claim to your insurance company. Please call the billing department at (989) 633-1459.

 

What does it mean when my statement says, "Submit to Wright & Fillippis?"
Per your Blue Cross/Blue Shield (BCBS) contract, your in-network provider is Wright & Fillippis. Please contact BCBS for further information.

 

What does it mean when my statement says, "Submit to Northwood/NPN?"
Per your Blue Cross/Blue Shield (BCBS) contract, your in-network provider is Northwood. Please contact BCBS for further information.

 

What insurances will you bill?
In general, we will submit a claim to all insurances on your behalf. However, for private duty care we do not bill Medicare, Medicaid or Blue Cross. We cannot guarantee payment by any of your insurance companies and any balance that is remaining after your insurance pays will be your responsibility. 

Hospitals

If I am treated in the hospital, what other bills will I receive?
In addition to your bill from the hospital, you may receive bills from other physicians who may have provided services to you. For instance, you may receive bills from consulting physicians, radiologists, anesthesiologists and other specialists. Please contact their office directly if you have questions concerning their bills.


Why was my account sent to Computer Credit, Inc. when I have been making payments?
This may happen when you do not pay your bill in full, but fail to contact us. We have an automated billing system; therefore it is very important that you contact Customer Service if you are unable to pay in full when you receive your first statement.

 

Why do I have more than one patient number when I am only one patient?
Unfortunately, our system is set up to give a new patient number for each encounter. If you are paying your bills and have more than one you may just write one check, but include each account number for which you are paying.

Nursing Homes

What qualification do I have to meet to qualify for Medicare benefits?
According the Medicare guidelines, residents must have first had a three-day qualifying acute hospital stay before Medicare will cover their SNF stay. Residents must be admitted to a SNF within 30 days of the three-day qualifying stay. The resident must require skilled nursing services on a daily basis, or skilled rehabilitation services five days a week. These services must be performed by or under the general supervision of a professional staff and, be provided on an inpatient basis in a skilled nursing facility.

 

How many Medicare coverage days can a resident receive?
Part A will cover up to 100 days of a resident’s stay in a SNF. According to guidelines, during the first 20 days of the 100 day period, Medicare will cover 100% of costs. After this, coinsurance-either private insurance or Medicaid, depending on the state-will become the secondary payer. Every year, CMS sets new rates for coinsurance. This year, Medicare has set a coinsurance charge of $105.00 per day for the days 21 through 100 of the resident’s stay. 

 

What does a resident do when Medicare benefits exhaust and/or are terminated and would like to become a permanent placement?
Arrangements would be made with the Business Office (billing) as to how the resident’s continuing stay would be covered. A resident would become either a Private Pay or Medicaid resident, whichever they qualify for. If a resident carries a Long Term Care Insurance that covers basis and/or custodial care, the resident would be a Private Pay resident and would be responsible for submitting the monthly claim to his/her Insurance carrier for reimbursement.

 

How does a resident go about applying for Medicaid?
Medicaid information and applications may be picked up at the Business Office. They will assist to the best of their ability in answering any questions or filling out the application.

 

Who pays for Leave of Absence (therapeutic overnight) and Bed-Hold (hospitalization) days?
If the resident were a Private Pay resident they would be responsible for payment any Leave of Absence and Bed-Hold days. Medicaid will pay for 18 Therapeutic Leave days in a 365-day period and up to 10 Bed-Hold days for each hospitalization as long as the patient pay amount as assigned by the State is met.

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