Frequently Asked Questions and
Glossary of Common Terms
District One Hospital wants to make every effort to assist you with your billing questions. Here is a glossary of common billing terms to help you understand your billing statement.
Account Number
An unique number that is assigned to you each time you visit the hospital.
Adjustment
A portion of your medical bill that is adjusted in accordance to the contract between DOH and your insurance company.
Amount Not Covered
The bill amount that the insurance company will not pay. It may include deductibles, coinsurances, and charges for non-covered services. For example, a non-covered charge could be food trays for visitors, personal grooming supplies, and take-home supplies.
Amount Payable by Plan
The amount your insurance plan pays or covers for your treatment, less any deductibles, coinsurance, or charges for non-covered services.
Benefit
The services that are covered under your insurance plan.
Coinsurance
The percent of coverage not covered under your insurance benefits. For example, your policy may cover 80 percent of charges. Your "coinsurance" or patient portion would be the remaining 20 percent.
Co-payment/Co-pay
A set fee established by the insurance company for a specific type of visit. This amount is due from the guarantor. This information can routinely be located on the insurance card and will be different amounts according to the type of visit. For example, Emergency Room Visit - $50, Inpatient Stay - $100, Physician Office Visit - $20.
Date of Service (DOS)
The date(s) when you were provided healthcare services. For an inpatient stay, the dates of service will be the date of your admission through your discharge date. For outpatient services and physician office visits, the date of service will be the date of your visit.
Deductible
An amount that must be met on an annual basis that is established by the insurance company and your benefits plan. Call your insurance company for the most up-to-date information regarding your deductible.
Explanation of Benefits (EOB)
This is a notice you receive from your insurance company after your claim for healthcare services has been processed. It explains the amounts billed, paid, denied, discounted, uncovered, and the amount owed by the patient. The EOB may also communicate information needed by the insured in order to process the claim.
Guarantor
The person responsible for payment of the bill.
Health Maintenance Organization (HMO)
An insurance plan that has contracted with providers to provide healthcare services at a discounted rate. These services will require prior pre-certification, authorization and/or referrals.
Managed Care
An insurance plan that has a contract agreement with hospitals, physicians and other healthcare providers.
Medicaid
A state-administered, federal-and state-funded insurance plan for low-income families who have limited or no insurance.
Medicare
A health insurance program for people age 65 and older, some people with disabilities under age 65 and people with end-stage renal disease (ESRD). For questions concerning the Medicare program, call the Social Security Administration toll-free at 1-800-772-1213, or call your local Social Security office.
Medicare Part A (Hospital Insurance)
Healthcare coverage for inpatient stays at participating hospitals.
Medicare Part B (Medical Insurance)
Healthcare coverage for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care.
Medigap
Medicare Supplemental Insurance available by private insurance companies that pays for some services not covered by Medicare A or B, including deductible and coinsurance amounts.
Non-Covered Services
Services not covered under the patient's insurance plan. These charges are the patient's responsibility to pay.
Out-of-Network Provider/Non-Participating Provider
The provider is not part of the insurance plan's network of contracted providers. Generally, services at out-of-network providers are paid for at a lower rate by the insurance plan and at a higher rate by you.
Out-of-Pocket Costs
The amount that you pay until your benefit coverage reaches 100 percent.
Point-of-Service Plans
An insurance plan that allows you to choose doctors and hospitals without first having to get a referral from your primary care physician.
Pre-Authorization Number
Authorization given by a health plan for a member to obtain services from a healthcare provider. This is commonly required for hospital services.
Pre-Certification Number
A number obtained from your insurance company by doctors and hospitals. This number will represent the agreement by the insurance plan that the service has been approved. This is not a guarantee of payment.
Preferred Provider Organizations (PPO)
An insurance plan that has a contract with providers to provide healthcare services at a discounted rate. These services may require prior pre-certification, authorization and/or referrals.
Referral
Approval or consent by a primary care doctor for a patient to see a certain specialist or receive certain services.
Subscriber
The person responsible for payment of premiums or whose employment is the basis for eligibility for a health plan membership.
Frequently Asked Questions
DOH wants to make every effort to assist you with your billing questions. Hear is a list of answers to frequently asked questions to help you understand your billing statement.
What are my payment options?
You can pay by check, money order, Visa, MasterCard, American Express, and Discover. Please include your patient number on any payment information you submit.
How long will it take my insurance company to pay their portion of the bill?
On average, an insurance company will process a claim within 45 days. DOH will follow up with the insurance company to expedite the resolution of the claim. At times you may need to contact the insurance company to assist in this process.
Why did my insurance pay only a part of my bill?
Most insurance plans require that you pay a co-payment, coinsurance, and/or a deductible for your healthcare expenses. Your bill may include charges that you are responsible to pay, such as non-covered items or out-of pocket expenses. Contact your insurance company for specific information pertaining to your coverage.
Why do I need to call the insurance company if they do not pay the bill?
If you have a PPO policy or an individual policy, you are ultimately responsible for the total bill or any portion of the bill your insurance plan does not pay. DOH will make every effort to collect payment on the account from your insurance company, but we may need your assistance to resolve any concerns.
How can I find out if my insurance has paid or how much they have paid?
When your insurance company processes your claim you should receive an explanation of benefits (EOB) in the mail. The EOB will contain payment information and the amount due from the patient. Contact your insurance company with questions about the status of a claim or how the claim was processed.
Why did I receive more than one bill for my hospital visit?
In addition to the hospital bill, you may receive bills for professional services you received during your visit. These ancillary bills are from providers such as radiologists, cardiologists, and/or pathologists. It is a legal requirement for these providers to submit separate bills for their services. The hospital is not responsible for the billing or collection of these services. If you have questions about these bills, please call the number listed on the billing statement.
What happens if my account is delinquent?
When a balance is due, you should receive two to three notices in the mail. If the account is not paid in full, it may be referred to our billing agency. If the account is not paid after further attempts to collect by the billing agency, the account will be sent to a collection agency.
How do I obtain an itemized statement?
Itemized statements will only be sent to patients upon request. A DOH itemized statement can be requested by calling 507-334-6451. A DOH itemized statement is sent monthly to the guarantor.
What if there is an error on my bill?
If you believe that your bill is incorrect, contact us and we will be happy to discuss it with you.
Financial Assistance
District One Hospital has a policy to provide charity care to patients who meet the eligibility requirements for such care. To find out more information about how we may be able to help, please call 507-332-4764.
