Billing & Insurance

Billing & Insurance

The healthcare billing and insurance process including hospital bills and insurance claims can be complicated – Mission Health participates with most primary commercial insurance providers, Medicare and Medicaid to help our patients manage their coverage for necessary and desired healthcare services.

Billing: Your Bill

Bills for hospital and doctor’s office visits, services and treatments include but are not limited to the following list. Patients may receive more than one bill for your visit, depending on services and treatments provided.

Hospital Bill:

Hospital services are provided at our hospitals’ main campuses and at many of our outpatient locations. Hospital bills may include:

  • Radiology, laboratory or other testing services
  • Operating room services, inpatient room and board charges
  • Emergency services (Note: If you are treated at one of Mission Health’s emergency departments, you will receive a separate bill from the physician who treated you)
  • Pharmacy, medical supplies and other services provided by the hospital
  • Ambulance services are separate from your hospital bill

Doctor’s Office Bill:

Bills for physician's services include office visits, examinations, interpretation of tests, surgical procedures and consultations performed by physicians and in some instances physician assistants. Physician services also include, but are not limited to, the services of anesthesiologists, radiologists (x-rays) and pathologists (labs). These services may be performed in a physician's office, on the hospital campus or in a hospital clinic.

Insurance: Coverage for Your Care

Contact your insurance provider about your health plan. Prior to a non-emergency visit to the hospital or physician's office, contact your insurance provider about your specific health plan to check that Mission Health and/or your doctor are participating in-network providers. If your insurance does not list your physician or Mission Health as in-network providers, your services may be considered "out-of-network" and you may be responsible for all or a larger portion of your bill. Learn more about coverage and billing for out-of-network healthcare services.

Authorization for healthcare services: Most health plans require pre-authorizations (or prior approval), particularly for elective services and may require that you notify your primary care physician. If your insurance provider determines your service is either not medically necessary or is not a covered service, they may not cover your care, and you are expected to pay the entire bill at the time of your visit. Deductibles, co-payments and any money due for your service will be requested either during your pre-registration process or at your initial registration. We provide Financial Assistance to eligible patients who are unable to pay for their medical services. Learn more about Financial Assistance.

Update your personal and insurance plan information. Bring your insurance cards, photo identification and authorization forms to every visit and present them at registration. We will ask you to sign forms, such as a release of information, and possibly additional forms depending on your type of visit. Please inform us of any changes in your insurance coverage – if your personal or insurance information, such insurance plan or address, is out of date, it can cause payment delays or denials that may ultimately leave you responsible for payments. Update your insurance or billing information.

Payment at the time of services. The amount of money patients can expect to pay at the time of service is based on estimated charges. Mission Health will send a bill for any balance remaining after insurance payments to the responsible party. If you have questions regarding your deductibles, co-pays and co-insurance payments, call your insurance company. Estimate the cost of your care in advance.

For Our Medicare & Medicaid Patients

Medicare

If you are a Medicare patient, you will be asked a series of questions regarding your retirement and any other insurance you may have. These questions are required by law and must be asked every time you receive services. We may need to bill your insurance company before we send the bill to Medicare. If you are covered by a group insurance or have a change in employment, please let us know when you check-in at the registration area. A change in your job or your spouse's job may affect how we are required to bill Medicare.

Medicare determines when a service is medically necessary. In the event that a service is not covered by Medicare, we may ask you to sign an Advance Beneficiary Notice (ABN). By signing the ABN, you agree to pay for services Medicare will not cover. Additionally, we will bill you and/or your supplemental insurance carrier for services not covered by Medicare such as routine health exams, self-administered drugs, and any tests Medicare deems as not medically necessary. If neither Medicare nor your supplemental insurance carrier covers these services, you will be responsible for payment.

Medicaid

If you have Medicaid medical coverage you must show your card at each visit, so that we may verify with Medicaid that you are eligible to receive services. If you are a member of Carolina Access, we will need the name and phone number of your primary care doctor. Your primary care doctor must refer you to Mission Health before Medicaid will pay for your hospital services.

Medicaid does not pay for certain services, even if your doctor orders them. You may need to pay all or a portion of the charges that are not covered. Please call your Department of Social Services (DSS) worker to make sure Medicaid will cover the procedure.