Dameron Hospital
   

Financial Information


INFORMATION REGARDING YOUR BILL

Hospital Billing Information

Your hospital bill will reflect services provided to you by the hospital during your stay.  Please contact our Patient Accounting Department at (209) 461-7583 with questions about your hospital bill.  To better assist you, please have your patient account number and date of your visit available at the time of your call.  A Patient Accounting representative is available to assist you Monday through Friday, 7:00 a.m. to 5:00 p.m., excluding holidays.

Professional or Physician Services

During your hospital visit, other professionals or physicians may be involved with your care and they have their own billing office. Charges for professional or physician services are not part of your hospital bill.  Professional or physician services include, but are not limited to:

Ambulance Services

Anesthesiologists

Emergency Department Physicians

Hospitalists

Pathologists

Physicians

Radiologists

If you provide us with insurance information at the time of your visit it will be made available to the professional or physician that provided you service.  Professional or physician service bills will come to you directly from the provider, and you should contact them with questions regarding their bills.  The hospital is unable to assist you with these claims. 

Dameron Hospital cannot make sure that the professionals or physicians who treat you are contracted with your insurance or provider network.

Services provided by a professional or physician who is not contracted with your insurance may be considered “out-of-network services.”  Your insurance benefits may be reduced for “out of network services.”  If your insurance benefits are reduced, this may increase your personal financial responsibility for “out-of-network services.”

Dameron Hospital personnel do not have access to a list of professionals and physicians who are contracted to your insurance.  If you have any questions regarding professionals or physicians who are contracted to your insurance, or about coverage or benefits, please contact your insurance plan or network administrator.

FINANCIAL ARRANGEMENTS

Patients Covered by Insurance

Your healthcare 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 remain 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 financial assistance programs.  Please contact the hospital’s Financial Counselor at 944-5400, ext 7525 for information on available programs or if you require assistance in applying for programs for which you may qualify. Signage in English and Spanish is posted in the hospital registration areas 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.

Uninsured Patient Discount

Dameron Hospital offers patients without insurance a discount on hospital charges. The discount rate will be reflected on the patient’s billing statement and will be mailed to the patient’s address obtained at time of registration.

Payment Plans
Ninety day payment plans for the amount owed may be arranged for those unable to pay their account in full. All accounts not paid within 90 days will be charged a FINANCE CHARGE of 10% per annum. It is important that you contact our office within 30 days of your first billing notice to discuss your payment options.

Delinquent Accounts

When an account becomes delinquent all cost of collection will be added to the original account, including court costs and attorney’s fees.  Accounts that are paid within the 30-day period following initial billing will not be subject to any additional costs.

FINANCIAL ASSISTANCE

Government Assistance Programs

If you are uninsured you may be eligible for medical assistance programs funded by County, State or Federal agencies.  We encourage you to contact our Financial Counselor at 944-5400, ext 7525 more for information about these programs.  Our Financial Counselor is available to assist you in applying for these programs Monday – Friday during normal business hours.  There is no cost to you for this assistance.

Charity Assistance Program

Dameron Hospital provides charity assistance to those individuals who demonstrate an inability to pay for services.  Below is an outline of the program. 

A.  Self pay patients (no third party coverage for services):  If you are self pay and your family income is over 350% of the Federal poverty level, or you do not apply for a discount, or do not supply proof of family income, you will receive a discount off of the hospital’s usual and customary billed charges.  The reduced charges will be automatically billed to you.

B. Self pay (no third party coverage for services) or Underinsured Patients whose family income is at or below 350% of the Federal poverty level:  If you are a self pay patient or a patient that has insurance, however your insurance does not contract with the hospital for a discount from the hospital’s usual and customary charges, and the annual out-of-pocket costs incurred by you at the hospital or other medical provider exceeds 10 percent of your family’s income in the prior 12 months, you may be eligible for a reduction of your bill.
If your family income is at or below 350% of the poverty level and you apply for and provide proof of income, you may be eligible for a reduction of your bill to the amount that the hospital would receive from the government’s Medicare program.  We will adjust your balance upon your qualification and bill you at the reduced rate.  You will also qualify for an interest free payment plan that you and the hospital can negotiate that is reasonable for the amount you owe.

Financial Indicators Used and Supportive Documents Required to Support Financial Condition:

Current Employment Pay Stubs For All Working Family Members (or)

Last Year’s Tax Return

C.  Self pay or insured patients whose family income is below 250% of the Federal poverty level:  Self pay and insured patients whose insurance contracts for and receives a discount from the hospital’s usual and customary charges may qualify for a full or partial reduction of your bill.
If your family income is below 250% of the federal poverty level and you are uninsured or you have a large patient responsibility after your insurance pays their portion in relation to your family income, and if you apply for and provide proof of income and assets, you may qualify for a full or partial reduction in the balance you owe.
Dameron utilizes the following financial indicators to identify whether a patient or patient’s representative demonstrates the qualifications necessary for full or partial charity assistance.  If it is determined that you qualify for a partial reduction in the balance you owe, you will also qualify for an interest free payment plan that you and the hospital can negotiate that is reasonable for the amount you owe.

Financial Indicators Used:

The employment status of the patient, spouse, or parents along with the prospect of future earnings being sufficient to meet the obligation within a reasonable period of time.

Family size

Net worth will be considered including all liquid and non-liquid assets owned, less liabilities and claims against assets.  Retirement and deferred-compensations plans qualified under the Internal Revenue Code as well as nonqualified deferred-compensation plans shall not be used in determining net worth.  Furthermore, the first $10,000 of a patient’s monetary assets shall not be counted in determining eligibility, nor shall 50% of a patient’s monetary assets over the first $10,000. Note: The hospital may require waivers or releases from the patient authorizing the hospital to obtain verifying information from financial or commercial institutions, or other entities that hold or maintain the monetary assets to verify their value.

The amount(s) and frequency of the hospital bill(s) in relation to the factors outlined above.

All other resources will first be applied, including Medi-Cal, Medicare, VOVC, and all other third-party sources.

Patient’s financial reports (i.e. tax returns, W2 forms, pay stubs, etc.) may be used to verify inability to pay as well as investigative tools by the Credit & Collection Dept. (i.e. credit reports, skip tracing, etc.)

Supportive Documents Required Supporting Financial Condition:

Federal and State Income Taxes (most recent two years)

Copies of Savings or Checking Account(s)

Copies of last 2 employment pay stubs

For information regarding poverty thresholds visit the U.S. Department of Health and Human Services website at http://aspe.hhs.gov/poverty/, or call (209) 461-3147.

If you would like more information, or an application to apply for any of these programs please contact us at (209) 461-3147 to speak with one of our financial counselors.

Professional or Physician Services

Charges for professional or physician services are not part of your hospital bill.  If you provide us with insurance information at the time of your visit it will be made available to the professional or physician that provided you service.  Professional or physician service bills will come to you directly from the provider, and you should contact them with questions regarding their bills.  The hospital is unable to assist you with these claims. 

Dameron Hospital cannot make sure that the professionals or physicians who treat you are contracted with your insurance or provider network.

Services provided by a professional or physician who is not contracted with your insurance may be considered “out-of-network services.”  Your insurance benefits may be reduced for “out of network services.”  If your insurance benefits are reduced, this may increase your personal financial responsibility for “out-of-network services.”

Dameron Hospital personnel do not have access to a list of professionals and physicians who are contracted to your insurance.  If you have any questions regarding professionals or physicians who are contracted to your insurance, or about coverage or benefits, please call your insurance plan or network administrator.




Dameron Hospital Association
525 West Acacia Street, Stockton, CA 95203   Tel: 209.944.5550
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