如果你有保险或医疗保险, 公司会给你一份福利说明. You will not receive a statement from the hospital until we have heard from your insurance company. That statement should agree with the information you received from the insurance company. In order to assure 那 this insurance information is accurate, it is very important 那 you provide us with updated insurance information. 如果你 do not have insurance, you should receive a statement within 60 days of your services.
How long will it take to get things settled with the insurance company?
The length of time for claims to be processed by an insurance company can vary. One of the primary considerations is when the hospital submits the claim. It can take anywhere from 7 days to a month for the hospital to send the claim to your insurance, depending on the type of services provided and physician documentation. Once the claim has been submitted, most insurance companies process payment within 2-4 weeks. 然而, claims involving liability questions or the need for additional documentation may take longer. 如果你有一份以上的健康保险, the claim to the second insurer cannot be sent until the primary payer has finished correctly processing the claim. 同样重要的是, if you receive any correspondence from your insurance company asking for additional information, 你反应迅速, 因为索赔将保留到收到你们的答复.
Medicare is designed to cover a broad spectrum of services for Medicare beneficiaries. 然而, by federal statute, there are certain services and items 那 are not covered. 其中最常见的是自我给药. 当你是专科门诊病人时, 门诊手术, 急诊室或观察室), Medicare prohibits us from billing Medicare for any drug 那 can be self-administered by the majority of patients. This would include tablets, liquids, salves and creams, and inhaled medication. 还包括胰岛素. 除了胰岛素, it does not matter whether the individual patient is capable of administering the medicine, 只要求把这种药归为自我用药. Insulin will be covered in a case where a patient is in a diabetic coma. Other instances where you may receive a bill after Medicare and your supplement has processed a claim is when the hospital informed you prior to the service 那 we felt 那 the particular service does not meet Medicare’s 医疗 Necessity Rules or their frequency guidelines. 在这些情况下, we would require you to sign an Advanced Beneficiary Notice (ABN) prior to the service, either refusing the service or acknowledging 那 you will be responsible for the cost.
我认为你们把我的索赔提交错了. My insurance pays for an annual physical and you show 那 the company denied the claim.
Under the rules of the 病人 Protection and Affordable Care Act (PPACA), many insurance companies do cover the cost of an annual wellness exam. 然而, it is important to know what this wellness exam is not. The rules apply to visits for “symptom-free and disease-free individuals”. Conditions which require additional evaluation or treatment are not considered preventative in nature. 如果您需要额外的评估或治疗, an appropriate office visit charge will also be submitted to your insurance company. 如果你, 根据您的医疗保健提供者的建议, 决定进行实验工作, your insurance company will receive a separate claim for all the lab work done. These services may or may not be covered by your insurance company. Be advised 那 “screening’ is designed for a person who has not yet been diagnosed with a particular disease. 例如, your insurance company may allow for lipid screenings on an annual basis to determine if you have high cholesterol. If it is determined 那 you do have hyperlipidemia, you may not be screened for it any longer. Your provider will order periodic tests to monitor your condition to check the efficacy of your medication, 饮食, 锻炼计划, 但是一旦你得了这种病, 你可能不再有资格享受免费放映. 同样的道理, 你的医生可能会要求你做实验室筛查, 比如钾, 那, 当它在筛选时, 你的计划不是100%承保吗. Just because a test is ordered as a result of an annual wellness exam does not guarantee 那 the screening is a free preventive service covered by the PPACA. It is also possible 那 you presented to the office requesting a physical required by your employer or for a DOT physical. 如果去办公室的目的是进行工作体检, health insurance companies will frequently deny coverage for the visit. If a patient presents for an annual wellness visit and asks for an employment physical form to be completed at the end of the visit, it will be up to the provider to determine if the annual wellness visit covers everything required by the employment physical. 如果就业体检需要额外的评估, the visit will be considered an employment physical and not an annual wellness exam. 这对于DOT物理检查总是正确的.
There are times 那 the VA and/or ChampVA will require the patient cover some or all of the cost of services. 例如, if services are provided in the emergency room and the VA determines 那 the patient could have safely sought treatment at the Emergency Department of a VA hospital, 退伍军人事务部不会支付这次访问的费用. Neither will the VA cover outpatient services 那 have not been preapproved by the VA. ChampVA often has a coinsurance/copay required for certain outpatient services.