Billing Questions

Billing Questions

Our priority at Northwest Specialty Hospital is to give our patients the highest quality of medical care at an affordable rate.

To our patients

Finances can be difficult topic for discussion. That is why our patient account representative treats each patient’s finances with the highest regard for confidentiality. We work with you individually for a payment plan that meets your personal budget.

Verifying insurance benefits

Our insurance verification clerk calls your insurance prior to surgery to obtain all benefit information including deductible and co-payment amounts. Our patient representative may call you to discuss with you the deductible and co payment amount prior to, or on the day of your scheduled surgery. You may be asked to pay the deductible that has not been satisfied, or the HMO co payment that is required on the date of surgery.

Billing your insurance

As a courtesy for you, we will bill your insurance. We request that you present your insurance card and ask you to complete a patient information form. This form enables the billing department to appropriately bill your claim and notify you of your account status. We ask our patients to sign a medical record release authorization. This form allows us to release medical information to your insurance company if requested. You may be asked by your insurance company to provide additional information. Not responding to your insurance company can result in delaying or complete denial of your claim. Please call our billing department. They will be able to assist you.

Insurance denial

Your insurance may deny your claim for various reasons. Our billing representative may contact you for additional information. If there is no response from you, the account balance will be placed in a patient responsibility status. When the insurance denies your claim and there is no claim review requested, the balance will become your responsibility.

Appeal rights

Our facility has appealing rights with contracted insurance carriers. We will, if necessary, submit a request to your insurance company requesting a medical claim review. However, with non contracted carriers, you may be asked to appeal your claim in writing to your insurance company. Our billing department will be happy to give you appealing guidelines.

Payment arrangements

Our medical facility is not a financial institution, but we will agree to work out payment arrangements for our patients. If there is no insurance involved, our patient representative will contact you for payment arrangements prior to your surgery. A 25% down payment is required on all payment arrangements unless other arrangements have been. The patient representative may also find it necessary to call you if the insurance has denied your claim or your deductible has not been met. You will be requested to sign a payment arrangement that agrees to a specific monthly payment until your account is paid in full. If you do not honor this agreement, we will consider your account delinquent and a collection process will begin. If you have a financial hardship, please call our patient account representative.

Refunds

When a credit is detected on your account, our office manager will investigate. If the insurance has overpaid, we will contact your insurance company for further information. The insurance may request a refund from us. If your account has a credit, due to the payment from you and your insurance company, we will issue the refund directly to you. When there is more than one insurance company involved on your account, we will call your insurance companies to have them determine the coordination of benefits, if applicable. Please direct all calls regarding refunds to the office manager.

Statement

You will receive a monthly statement unless state and federal laws dictate otherwise. The statement will show all activity on your account. If you have any questions regarding your statement, please call the billing department. Let the department know of any name, address, or insurance updates so that your account can be properly credited.

Your statement will show an account balance and a patient balance. When your insurance has paid, your balance will appear in the patient balance column. If you receive a statement with the account balance amount showing only, we would like for you to beware that your insurance company has not paid. Please feel free to call them to inquire. The billing department will also be glad to assist you.

Finance Charges

Finance charges are not being generated at this time. However, we are registered with the Idaho Department of Finance to generate finance charges for our account receivables and have opted to not implement them at this time.