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Frequently Asked Questions About Your Bill

Finance Department

(303) 498-3600
8:00 a.m. – 4:30 p.m. – Monday through Friday 

 


 

Can I receive treatment at PVMC if I don’t have insurance?

As a not-for-profit organization PVMC makes quality healthcare services available to all citizens of Colorado regardless of their ability to pay. However, prudent financial management of all patients’ accounts enables us to continue to meet the needs of our community and help keep down the cost of healthcare.

 


 

Does my insurance company require pre-certification or a second surgical opinion?

Many insurance plans have pre-certification and/or second surgical opinion requirements. Generally, patients or their physicians are responsible for obtaining pre-certification from the hospital. To avoid any penalties or reduction of payments, for which you may be responsible, call your insurance company or employer for specific information.

 


 

What if I have more than one insurance company?

Often patients are covered by more than one insurance company, including Medicare and CHAMPUS. As long as you provide complete and accurate information to our registration staff, the hospital will help with the coordination of benefits among your insurance companies to ensure timely and accurate payment of your bill. This coordination of benefits among multiple insurance companies is a complex process, but our staff is well qualified to help you get the maximum benefit from your health coverage.

 


 

How much time is allowed for payment of my bill?

We request full payment within 60 days from the date of the billing. As a courtesy, we will bill your insurance(s) for you. If your insurance company does not respond within 45 days, you will receive a notice, in data-mailer or letter format, notifying you of their failure to respond.

 


 

How much of my bill will the insurance company pay?

The amount you pay depends on your policy. Most insurance companies require patients to pay a deductible and a percentage of the remaining cost of services (co-payments). Many insurance plans require pre-certification and will penalize you if it is not obtained. There also may be services for which your policy does not provide benefits and for which they will not pay. It is a good idea to study your insurance policy and talk to your employer or insurance representative if you have specific questions about your insurance plan.

 


 

I went to the Emergency Department, but the insurance company says it won’t pay my claim. Why?

Insurance companies have their own specific definitions of what constitutes an emergency. What seems like an emergency to you, may not be an emergency according to your insurance company. If this happens, your insurance company may make you partly or wholly responsible for payment of the bill. Once a managed care enrollee comes to a hospital that offers emergency services, the hospital must provide the services required under the anti-dumping statue without regard for the patient’s insurance status or any prior authorization requirement. Some managed care plans also require that a physician who is a participating provider, be involved in decisions regarding your treatment, or the insurance company will not pay. Talk to your employer or insurance representative if you have specific questions about your insurance plan.

 


 

Will I be asked to make a prepayment?

The hospital, upon verification of your insurance benefits, may learn that your insurance plan will not cover all services or that it includes co-payments and/or deductibles. We will attempt to inform you of those benefit requirements and to arrange for financial arrangements that meet your needs prior to elective services.

 


 

What method of payment can I use?

PVMC accepts cash, personal checks, MasterCard, Visa, Discover, and American Express.

 


 

I have Medicare. Do I have to pay anything?

Yes. The federal government requires you to pay a deductible for each “episode” of illness that puts you in the hospital as an inpatient. For each episode of illness, Medicare covers your expenses for 60 days, minus your deductible, which is determined each year by the federal government. If you are discharged and readmitted to the hospital within 60 days, you don’t have to pay the deductible again. The government considers any hospitalizations that occur within the 60 days of each other a single “episode” of illness. However, if you are discharged and readmitted more than 60 days later, you do have to pay another full deductible. Medicare currently gives you 30 “co-insurance” days, in which you are responsible for paying a fixed, per day rate. If you are hospitalized for more than 90 days, you can use your 60-lifetime reserve Medicare Days. It will be your choice to use your reserve days. There is a higher fixed per day rate for your lifetime reserve days. If you are hospitalized more than 150 days, your Medicare benefits will run out.

 


 

What can I do if I need help to pay my hospital bill?

Our trained financial counselors are available to discuss your individual needs. If you do not have insurance or if you may have difficulty paying any portion of the hospital bill not covered by insurance, financial counselors can help you apply for public assistance or arrange a payment plan. If you have a concern about payment and have not spoken with a financial counselor, please call 303-498-1510 or 303-498-1509 immediately.

 


 

Does Platte Valley Medical Center accept patients with TRICARE- CHAMPUS military insurance?

Platte Valley Medical Center is willing to provide medically necessary care to anyone. TRIWEST does not have specific precertification and authorization requirements. However, certain surgical procedures and diagnoses require a physician to obtain precertification. Also, both inpatient and outpatient services require a non availability statement before care is received at a non-military facility when the beneficiary lives within 40 miles of a military treatment facility.

 


 

How does Platte Valley Medical Center determine its charges? Why is health care so expensive?

The price of any item or service is determined by many factors, not simply the cost. Healthcare in the U.S. is the most advanced in the world. New technologies are being developed constantly that allow diseases and injuries to be treated that were untreatable only a few years ago. The cost of this technology and the cost of the skills and expertise of the people in the hospital who care for you make up a large part of your hospital bill. There is another reason why your bill is so high. Many people in Colorado have no health insurance and cannot afford the health care they need. Some of the cost of caring for those who can’t pay is passed along to those who can.

 


 

What is Platte Valley Medical Center doing to control costs?

Platte Valley Medical Center uses many strategies to control the cost of services. Although we are rated very highly by many measures of quality and patient satisfaction, we continuously strive to improve our delivery of medical services and administrative services. We are firmly committed to providing health services to our community that are of the highest quality and lowest possible cost. However, government regulations, current social policies, an increasing number of indigent and uninsured, and an aging population have a tremendous impact on the rising cost of heath care in this county.

 


 

Will all my charges be on one bill?

Your hospital bill will reflect only those services actually provided by the hospital, including your room charge, nursing care, medications and the use of hospital facilities such as operating rooms. Physicians and surgeons providing services individually or through a professional corporation, such as radiologists, anesthesiologists, psychiatrists, radiation oncologists, pathologists, emergency department physicians and others are independent contractors. You will receive separate bills for their services.

 


 

I was charged for services that I don’t remember having. Doctors I never saw charged me. What’s going on?

You may indeed have been charged for services you don’t remember. For example, you may have had an x-ray while you were asleep in surgery, or you may be charged separately for the pathologist’s work in the laboratory even though you did not actually see the physician. The anesthesiologist (the doctor who put you to sleep) also may send you a separate bill. Occasionally, your doctor may call in a consulting physician to review your case. If that happens, you will receive a separate bill from this doctor.

 


 

Why do I get one bill from the doctor and one bill from the hospital? Why aren’t they together?

To preserve the independence of the doctor-patient relationship, PVMC does not employ physicians. As a result, each physician practice manages its own business including its own billing. In addition, several federal laws govern the way hospitals and physicians can bill Medicare and private insurance companies. The requirements for hospital bills and physician bills are different enough to prevent the production of a joint bill.

 


 

Will I receive a refund if I overpaid my share of my bill?

You will be refunded any over payment that is due to you. It may take several weeks, however, for all payments and balances to be reconciled and for any refund check to be sent to you.

 


 

Can I get a copy of my bill?

Yes. An itemized bill will be sent if requested. Call (303) 498-3600 to receive a copy of your bill.

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