FINANCIAL ARRANGEMENTS

Patients Covered by Insurance
Your health care insurance is a contract between you and your insurance company. You should familiarize yourself with the terms of your insurance coverage. Please provide us with your insurance information at the time of registration.  We will submit a claim to your insurance as a courtesy, however, you are responsible for your account. You will be asked to assign your insurance benefits directly to the hospital. Amounts not covered by insurance, such as deductibles or co-pays, will be due prior to discharge. For your convenience, MasterCard, Visa, American Express and Discover cards are accepted.

Verification of Insurance Coverage
It is the responsibility of the patient or patient’s representative to verify that their insurance covers services rendered at Dameron Hospital.

HMO or PPO
Your plan may have special requirements, such as receiving services from a preferred provider or prior authorization for certain tests or procedures. It is your responsibility to make sure the requirements of your insurance plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services you receive. Some professional or physician services may not be contracted within your insurance company’s “provider network.”   If an out-of-network professional or physician provides you services, it is likely that you will be responsible for those expenses.

Medicare
We will need a copy of your Medicare card to verify eligibility and to process your Medicare claim. Deductibles and co-payments are the responsibility of the patient, unless supplemental insurance information is provided. You should be aware that the Medicare program specifically excludes payment of certain items and services.  For more information about your Medicare coverage please refer to your Medicare & You handbook.  If you do not have a handbook, you can visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for assistance.

Medi-Cal
We will need a copy of your Medi-Cal Benefits Identification Card (BIC) to verify eligibility and to process your Medi-Cal claim. Medi-Cal also has payment limitations on a number of services and items. Some Inpatient/Outpatient services require a Treatment Authorization Referral (TAR) from your primary care physician.  Please have this referral with you when you arrive for registration.

Prior Authorization/Non-Covered Services
Depending on your insurance, services ordered may require prior authorization. Failure to do so may result in non-payment for services rendered. Please contact your insurance company to ensure services are covered.

Patients Not Covered by Insurance
We encourage our uninsured patients to apply for assistance programs.  Following discharge from the hospital you will receive an itemized bill along with information on how to apply for financial assistance.  Signage in English and Spanish is also posted in the hospital registration area and Emergency Department to provide patients who don’t have insurance with information on what to do.

Except in the case of emergency, patients without insurance are required to pay a deposit at the time of registration. This is a deposit only.  Payment on the account balance is due within 30 days of the initial billing, unless other payment arrangements have been made.  If payment is not received within 30 days, the account will become delinquent and a FINANCE CHARGE of 10% per annum may be charged.  For your convenience, MasterCard, Visa, American Express and Discover cards are accepted.

FINANCIAL ASSISTANCE

Government Assistance Program
If you are uninsured you may be eligible for medical assistance programs funded by County, State or Federal Agencies.  Please contact our Patient Accounting Department for more information about these programs.  A hospital representative is available to assist you in applying for these programs.  There is no cost to you for this assistance. We encourage you to apply. 

Uninsured Patient Discount
If your income is at or below 350% of the Federal poverty level and you are uninsured, you may qualify for financial assistance.  Please contact our Credit and Collections Department to speak with a representative about our charity assistance and discount programs. 

Financial Assistance for Patients Not Covered by Insurance
If your income is at or below 350% of the Federal poverty level and you are uninsured, you may qualify for financial assistance.  Please contact our Credit and Collections Department to speak with a representative about our charity assistance and discount programs. 

Financial Assistance for Patients Covered by Insurance
An insured patient that falls at or below 350% of the Federal poverty level who does not receive a discounted rate as a result of third party coverage, and has annual out of pocket medical costs in the prior 12 months that exceed 10% of family income, may be eligible for financial assistance.  Please contact our Credit and Collections Department to speak with a representative about our charity assistance and discount programs. 

How do to apply for Financial Assistance
Charity assistance application forms may be obtained from the Registration Department, or by calling our Patient Accounting Department. The Patient Accounting Department will mail you a form to complete including instructions on where to mail the completed application and required income documentation. 

Payment Plans
Payment plans that are reasonable for the amount owed may be arranged for those unable to pay their account in full. A FINANCE CHARGE of 10% per annum will be charged. It is important that you call our office within 30 days of your first billing notice to discuss your payment options.