Avera Queen of Peace Hospital Bills and Insurance

We’re pleased to provide this information to help you understand the patient billing practices at Avera Queen of Peace.

If You Have Health Insurance

Your insurance company should give you a pre-authorization number, if you are having an elective procedure. This number should be given to Admitting personnel when you are admitted, or as soon after admission as you obtain it. As a courtesy, our Business Office will submit your insurance claim to your insurance company(s). We will need a copy of your insurance identification cards for all insurance coverage. After assigning insurance benefits to be paid directly to the hospital, you will be expected to pay only the amount which is not covered by your insurance. Your bill is due in full within 90 days of the date of discharge regardless of the status of insurance payments. If your insurance company is unable to make payment on your claim within 90 days of the date of discharge, please notify our business office.

Your insurance plan may have special requirements such as pre-authorization for certain tests, procedures, or admissions. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Remember…your policy is a contract between you and your insurance company and, therefore you, not your insurance company, have final responsibility for the timely payment of your hospital bill. All patients should familiarize themselves with the terms of their coverage. Medical bills and how they get paid can be very confusing. For additional information on how our billing process works, please refer to the yellow "Billing and Follow-up Information" sheet that you received from Admitting during your registration.

If Your Services Are Accident Related

If your hospitalization or services result from an accident for which a third-party bears responsibility, you may be asked to provide information about possible indemnity payments to allow recording a notice of a hospital lien to such responsible parties. We ask for your cooperation in providing any information and other assistance requested to permit these resources to be used to pay your bill, as appropriate.

If You Are Covered by Medicare

We will need a copy of your Medicare card to verify eligibility and process your claim. You should be aware that the Medicare program specifically excludes payment for certain services and items. Deductibles, co-insurance, and non-covered amounts are the responsibility of the patient. Please refer to the Medicare handbook that the Medicare program provides to all Medicare beneficiaries.

Medicare Part-A (Acute care) Coverage

Medicare Part A helps pay for up to 90 days of care in each benefit period. A benefit period starts when you begin a hospital stay. A benefit period ends when you leave the hospital and have been out of the hospital or skilled nursing home for 60 days in a row. Part A also gives you 60 "reserve days". Reserve days help pay for hospital care if you use up your 90 days in a benefit period. Reserve days cannot be replaced once you use them. You have 60 reserve days in your lifetime. You can decide when you want to use your reserve days. After you have been in the hospital 90 days, you can use all or some of your 60 reserve days, if you wish. If you do not want to use your reserve days, you must inform the hospital in writing either when you are admitted to the hospital, or at any time afterwards up to 90 days after you are discharged. If you use your reserve days and then decide that you did not want to use them, you must request approval from the hospital to get them restored.

If You Are Covered by Medicaid

We will need a copy of your current Medicaid card to verify eligibility and type of coverage. If you are covered under the Medicaid Managed Care program, it is your responsibility to present your Medicaid card at/prior to admission. You may also be required to contact your primary care physician for a referral (in non-emergency cases), and to verify that all the requirements of the program have been met.

If You Have No or Limited Insurance

Patients without, or with limited insurance are expected to meet with our Business Office staff to discuss payment arrangements. Avera has a financial assistance policy for patients who may not be able to pay. This policy provides for charity care/financial assistance for healthcare services. Patients with balances due resulting from limited or no insurance coverage may qualify for our charity care or financial assistance programs after all other third party resources, including county poor relief, have been exhausted. These programs are designed to assist patients who are either financially or truly medically indigent.

A financially indigent patient is uninsured or under-insured and is accepted for care with no obligation or a discounted obligation to pay for services based on income and family size. The hospital uses poverty income guidelines issued by the U.S. Department of Health and Human Services to assist in determining a person’s eligibility for care as a financially indigent patient. Please contact the Business Office for additional information regarding this policy or to apply for financial assistance.

A medically indigent patient is one whose hospital bills after payment by third party payers exceed the patient’s financial resources available and the person is unable to pay the remaining bill. Avera considers all financial assets and liabilities of the patient when determining ability to pay. The patient is responsible for providing information requested during the qualification process and will continue to receive a bill until eligibility has been determined. Please contact the Business Office at (605) 995-2236 for more information about these programs.

Your Hospital Bill

Your bill reflects the charges for all of the services you received during your stay. Charges fall into two categories. The first category is a basic daily rate which includes your room, meals, nursing care, and housekeeping. The second category includes charges for special services which include items or tests that your physician orders for you; examples of such are x-rays or laboratory tests.

Your Separate Physician Bill

If you have certain tests or treatments in the hospital, you may receive bills from physicians or specialists you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, anesthesiologists, and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from the physician(s) or specialist(s).

What We Will do for You

• We will bill your insurer(s) on your behalf.
• We will provide regular monthly statements for each service visit.
• Our Business Office will provide assistance with any questions you may have.
• You will be treated with dignity and respect, regardless of your ability to pay.

What We Need in Order to Serve You

• Provide us with complete health insurance information upon registration.
• Please understand and comply with the requirements of your insurance coverage.
• Please respond promptly to requests you receive from your insurance company.
• Payment plans must be formally arranged with our Business Office.
• Please make timely payments on your portion of the bill.
• Please let us know if you anticipate problems paying your portion of your bill. It is our mission to assist those in need or those with extenuating financial situations. Our Business Office can discuss payment alternatives that may be available, but we first need to hear from you on a timely basis.
• Please call us if you have any questions or concerns about a bill.