Access the information below to see frequently asked questions. For further assistance, please contact Patient Accounts at 641-672-3315.
Billing & Financial Questions
What is provider-based billing?
Provider-based billing is used across the U.S. by many healthcare systems, like Mahaska Health. When you see a physician in a hospital-based outpatient clinic, physician and clinic (facility) charges are billed separately. Hospital-based outpatient clinics are considered a department of the hospital; “private” physician offices are not (generally, these are smaller physician offices out in the community). Hospital-based outpatient clinics are subject to stricter government rules, making them more complex and more costly to operate.
When you see a physician or receive services in a hospital-based outpatient clinic, you are technically being treated within the hospital rather than the physician’s office as these offices are considered a department of the hospital. Even though you’re seeing your regular physician in a clinic setting and not actually hospitalized, your visit is billed under the hospital rather than the physician’s office.
Will I pay more for services?
Your statement will show a separate charge for professional fees (clinic charges), and technical fees (hospital charges), but the combined total will not change. Depending on your specific insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge. The increase in cost is a result of the health plan’s coinsurance and deductible, so not an increase in actual fees. People with a supplement plan are not likely to see much change.
Will my appointment be different?
Your clinical care will not change. You will continue to see your regular doctor and health care team and continue to receive excellent-quality care. Scheduling appointments and tests will be handled as they have been in the past. At every visit, Medicare patients will be asked to complete an MSP questionnaire containing 10 to 15 questions. We recognize this may feel repetitive, but it is a government requirement.
What if I have questions?
We ask you to review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. If you have additional billing questions, you can contact our Billing Office at 641-672-3315.
What should I ask my insurance carrier?
Making informed health care purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible or subject to insurance.
Mahaska Health is dedicated to helping you understand and prepare for potential out-of-pocket costs related to medical services you or a loved one may receive at our hospital.
The file below is a list of the hospital’s standard prices for items and services organized by charge code. The hospital’s charges are the same for all patients, but a patient’s responsibility may vary due to a number of reasons including:
- The charge for the service
- How many codes are included in the service
- What insurance approves and pays
- What amounts are applied to the deductible, copay or coinsurance
At Mahaska Health, we want to help you determine what your out-of-pocket cost is going to be so that you can make informed choices about your healthcare. Financial Counselors are available to help you prepare for the cost, understand the payment process and avoid financial surprises.
Contact a Financial Counselor for an estimate of out-of-pocket costs by calling 641.672.3315
Will the hospital bill my primary and secondary insurance?
Yes, as a courtesy to you, Mahaska Health will submit bills to all of your insurance companies. You will need to provide us with complete information on all insurances. Some insurance companies require additional information from the patient before they will process a claim. In this instance, it may be necessary for you to contact your insurance company and provide them with the additional information.
Will I receive an itemized statement?
Itemized statements are sent only if you request one. To request an itemized statement, please call 641.672.3315, between 7:00 am – 4:30 pm Monday through Friday.
Do you offer payment arrangements?
Yes, payment arrangements may be made by contacting us at 641.672.3315, between 7:00 am – 4:30 pm Monday through Friday.
Why did I receive separate bills for the hospital and the doctor(s)?
Physicians, pathologists, radiologists and other specialists submit separate bills. If you have questions about these bills, please call the number printed on your statement.
I stayed overnight in the hospital. Why is this billed as an outpatient stay?
The physician who ordered your service determined that your condition did not meet the criteria for an inpatient admission. The physician’s written order determines if we bill as an inpatient or an outpatient.
Medicare and my supplement always pay my bill in full. Why do I have a balance due?
Medicare will not pay for self-administered drugs given to a patient on an outpatient basis. If you were in the emergency room or were an observation patient you may be required to pay for drugs that Medicare determines as self-administered. Medicare also has medical necessity checks on certain outpatient tests. If Medicare has determined your test to be not medically necessary, you will be required to sign an Advanced Beneficiary Notice prior to the test being performed. The test(s) will then be your responsibility. Normally, if Medicare does not pay for a test your supplement will not pay for it either.
Why should I contact my insurance company if they do not pay my bill?
We will make every effort to resolve your account with your insurance company. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance. If your insurance company is questioning the responsibility of another third party payer, usually they will only accept information from the patient or the subscriber.
What is a co-payment?
A co-payment is a set fee you pay to the provider at the time services are rendered. Co-pays usually apply to emergency room and office visits. The costs are usually minimal.
What is a deductible?
A deductible is a set amount that you must pay before your insurance benefits will pay. For example, if a your policy has a $500 deductible, you must pay $500 out of pocket before your insurance carrier will pay benefits. Once you have met your deductible, your insurance carrier will usually pay the remainder at a specified percentage based on your policy agreement.
What is co-insurance?
Co-insurance is a percentage of your bill. For example, after your deductible has been satisfied, your insurance carrier will usually pay the remainder at a certain percentage, such as 80 percent. The remaining 20 percent will be your responsibility.