What to Expect

 

Physicians Regional - Billing and Insurance Questions

 

Billing and Insurance Questions?

If you have any questions regarding your account, please do not hesitate to call our Customer Service Department at:

Collier Boulevard (239) 354-6023

Pine Ridge (239) 354-6349

Prior to Services

Once you or your physician schedule services, our pre-registration team begins preparing for your visit immediately.

An insurance verifier will begin by contacting your insurance carrier to obtain benefits for the service(s) scheduled. If an authorization number is required for the schedule services, the verifier will contact your primary care physician to insure an authorization is obtained.

The insurance verifier will calculate your estimated patient liability and detail your benefits. You will be contacted prior to your scheduled services, if applicable with your estimated liability.

If the insurance verifier experiences any delays in benefits or authorization for services, you will be contacted promptly.

Day of Services

Please arrive at least 30 minutes prior to your scheduled service to allow time to complete required paperwork. Please bring the following items required for registration:

After Services

We automatically bill your insurance and/or Medicare for these charges and you will be responsible for any outstanding balances. The daily hospital rate includes the cost of your room and general nursing care. There are separate charges for items, which apply to your care such as medications, operating room, oxygen, blood products, recovery room laboratory services, and diagnostic x-rays.

In addition to the hospital bill, you will receive a bill from your private physician, consulting physician, emergency room physician, radiologist, pathologist, anesthesiologist and non-emergency transport for any applicable service. Ambulance fees are also billed separately by the ambulance service. Questions about any of these bills should be directed to their respective office.

Our billing cycles depend upon the type of insurance you carry. The different categories are as follows:

  • Workers compensation
  • Medicaid
  • Medicare
  • Commercial/Blue Cross/Champus/HMO
  • Self pay (no insurance)


Workers Compensation

While we are waiting for your primary insurance to pay, the hospital will follow-up with the employer and/or insurance carrier until the account is paid. If the claim is denied, the account will be changed to a self-pay account and will be pursued per the guidelines listed below under Self Pay.

Medicaid

The hospital will follow-up with the case worker and/or insurance carrier until the account is paid. If the claim is considered a non-covered service under the patient’s policy, the account will be changed to a self-pay and will be pursued per the guidelines listed below under Self Pay.

Medicare

The hospital will follow-up with Medicare until the accounts is paid. After Medicare has paid, the deductible and/or coinsurance will be billed to the secondary insurance, if applicable. The hospital will follow-up with the insurance company per the guidelines listed below under Commerical/Blue Cross/Champus. If there is no supplemental insurance, the hospital will follow the Self Pay guidelines. If the patient has signed an Advance Beneficiary Notice at the time of registration, all applicable charges will be billed to the patient.

Commercial/Blue Cross/Champus/HMO

A claim is filed to the insurance company. If payment has not been received from the insurance company within 30 days, a statement is mailed to you asking for your assistance in getting the claim paid by your carrier. If payment is not received within the next 2 weeks, a second statement is mailed advising you that your insurance carrier has not paid the claim. The account is then reviewed for the insurance collectability and may be changed to a self pay account. We encourage your assistance in resolving the outstanding balance with your insurance carrier. Many times the insurance carrier will pay the claim more timely if the patient calls.

Self Pay

It is the hospital's policy to ask you to pay some or all of your estimated bill upfront. If however, full payment is not obtained at time of service, a statement is mailed to you following the completion of services asking for payment. A second statement is mailed two weeks later asking for payment in full or that acceptable payment arrangements are made with the business office. Please note that although the hospital will be flexible in this regard, we are not a financial institution and do not have the means for long term payment arrangements. Therefore, it is your responsibility to arrange appropriate arrangements to satisfy your debt.

In addition to the above steps, phone calls are made to patients in this category as a continuing effort to satisfy the balance due. If financial arrangements are still not made, we may be forced to forward your account to one of our collection agencies for further follow-up. This may adversely impact your credit history.


Hopefully, this has explained how your account will be handled. If you have any questions regarding your account, please do not hesitate to call our business office at:

  • Customer Service Department – Collier Boulevard (239) 354-6023
  • Customer Service Department – Pine Ridge (239) 354-6349