Billing Inquiries
Insurance
Gadsden Regional Medical Center accepts most insurance policies and will file them on your behalf if the information is turned in at the time of service. Be sure to bring your insurance cards with you for each occasion of service. This will assist the billing department in making sure your claim is filed correctly.
Your insurance is a contract between you and your insurance company. In most circumstances the hospital can only file the claim to your carrier. We can not guarantee that your bill will be paid. In the event that your insurance does not pay as you believe it should, it is your responsibility to work with your insurance company to have the claim paid promptly and accurately.
Co-Pay
Most insurance plans no longer cover at 100%. If your service is elective or non emergency, the hospital will attempt to contact your insurance in advance of your service to identify what your insurance will pay. We then compare your coverage to an average cost formula to develop an estimate of what you may owe for your service.
You will be requested to pay that estimated amount either at the time of registration or at discharge. In addition, if you have any previous accounts that are outstanding, you may also be requested to clear those accounts before receiving additional services.
Precertification
Most insurance companies require precertification on elective and non urgent services, both inpatient and outpatient. Penalties may be applied to your benefits if certification is not done in accordance with your insurance requirements. You could be held liable for the penalty your insurance applies. It is important that you become aware of any certification rules your insurance may have.
Your insurance card will generally describe any certification requirements. It provides a telephone number to call in to obtain a certification number. Most insurance companies will accept the certification call from you or your physician. They usually need to speak with your physician to obtain medical information regarding your services.
In order to help assure the patients services will be paid by the insurance, we may request postponement of elective and non-urgent services until the precertification is obtained. This is done only to help assure that your insurance pays the maximum benefits available to you. Although Gadsden Regional will assist you and your physician in meeting certification requirements, the hospital will not be responsible for penalties applied by the carrier.
Managed Care / PPO
Gadsden Regional Medical Center is proud to participate with many managed care plans; however, PPO plans and insurance carriers frequently change. It is the patients responsibility to verify with their insurance if the carrier is a current participant with one of our plans. The hospital is not responsible for penalties applied by the carrier for failure to use a participating provider.
Medicaid / Patient First
If you are a Medicaid recipient, you are probably enrolled in the state's managed care plan, called Patient First. This plan requires certification and approval by the patients gatekeeper for many services, just as many insurance companies do. We encourage you to always seek your medical care from your assigned physician first.
If you need specialized or emergency care, your assigned physician will instruct you on where to go for services. If you do not see your Patient First physician for referral, you may encounter delays in elective and non-urgent services until both the certification and the gatekeeper approval are recieved.
Medicare
Gadsden Regional Medical Center participates in the Medicare program and has a compliance plan in place to assure we meet the federal requirements of the program. For patients having supplemental coverage that pays deductibles and coinsurances, we will file on your behalf once Medicare pays. Patients not having supplemental coverage will be requested to pay their portion of the service at the time service is rendered.
Medicare and Medical Necessity
Rules of the Medicare program have changed significantly over the last few years. By law, the facility must screen Medicare patients to assure that the treatment being ordered by your physician meets Medicare guidelines for medical necessity. In cases where the test ordered does not meet Medicare's criteria for coverage, we will notify you. If you choose to proceed with the service you will be held responsible for the non covered portion of that service.
Bills From Physicians
Physicians are not employed by the hospital and therefore the hospital does not have any information regarding the bill for their services. If you receive treatment in our Emergency Room, you will get a separate bill from the doctor that treated you. Other doctors, such as Radiologist, Pathologist and Cardiologist may provide services as part of your treatment. You will also get a separate bill from them.
If you have a question regarding a bill from any of these providers, it is best to contact their billing office for information.
Questions Regarding Your Bill
The Business Services Department is open Monday - Friday, from 8:30 a.m. until 4:30 p.m. If you have a question about your bill, insurance payment, or a statement you received, please call us (256) 494-4061. If you would like to see someone in person you may stop by our Financial Counselors office, which is located on the first floor of the main building. It is always helpful to have your account number(s) readily available to assist us in locating your account.