Avera Sacred Heart Billing Questions and Information
Contact Avera Sacred Heart Hospital Business Office: 605-668-8109
Medical bills and how they get paid can be very confusing. We have tried to answer some more commonly asked questions. However, each situation has the potential to be different based on the circumstances involved. Please do not hesitate to contact your insurer or one of our business office professionals.
1. What information do I need to provide?
Our staff has already begun working on your behalf even before you arrived at the hospital. We have several professionals dedicated to making sure your medical bills are handled quickly and professionally. The people you speak with upon admission/registration gather information required to submit your claims accurately and completely, including some information in certain circumstances to comply with federal and state regulations to help ensure appropriate parties are notified should there be a determination that there is a third party or liability that should be responsible. If you have insurance cards you should bring them with you each time you visit the facility. In general, you need to provide the latest information regarding your address, phone number and insurance information.
2. Will I receive an itemization of my hospital charges?
We have found that most of our customers do not want to receive a detailed, itemized bill. Since the detailed itemization can be expensive to produce and mail, you will receive a one page summary bill at the same time the claim is filed to your insurance company for payment. However, we would be happy to send you an itemized bill any time you request one.
3. What are Precertification/Preauthorization requirements?
Depending on your plan, your insurance company may have requirements for you to contact them before you receive services from a hospital. In some instances you may need to contact your insurance provider up to a week ahead of planned hospital services. If you do not follow your insurance plan’s precertification/preauthorization requirements, they may not pay your hospital bill, leaving you with an unexpected bill to pay.
Whenever your doctor wants you to have hospital services, please consult with your insurance company to see if they require precertification/preauthorization.
4. What if I can’t pay my portion of the bill in full?
The business office staff will work with you on a payment plan that will work for your situation. We offer many alternatives to assist you in payment including, MasterCard/Visa acceptance, ability to pay by direct bank deduction, and payroll deduction for employee’s. We are more than happy to work with everyone in establishing repayment arrangements, however we can not help without hearing from you. Should you have extenuating circumstances and need special assistance please let us know so that we can help find a solution for you.
5. I do not have insurance or money to pay my bill,
what will happen to me?
We have many options for you. You may qualify for one of several government programs that will pay for your services. We will help you by understanding your situation and getting the ball rolling for these types of assistance.
If there are no programs available for which you qualify, Avera Sacred Heart has a financial assistance program that may be able to help you address your bill.
6. What if I have more questions that was not
addressed in this brochure?
Please call us. We want to help you with any questions you may have. You may reach us Monday through Friday at the following numbers. Special weekend or evening appointments may also be made if the situation can not be handled over the telephone.
Avera Sacred Heart Hospital Business Office
Avera Sacred Heart Medical Clinic Business Office
Interest will be charged on self pay balances after ninety (90) days.
A late discharge charge will be applied to inpatient accounts in those circumstances where discharge occurs after 2PM.
After 2PM a charge is added equal to one-half day’s room and board charge.
After 6PM a charge is added equal to one day’s room and board charge.
Important Message From Medicare
Your Rights as a Hospital Patient
- You have the right to receive necessary hospital services covered by Medicare, or covered by your Medicare Health Plan ("your Plan") if you are a Plan enrollee.
- You have the right to know about any decisions that the hospital, your doctor, your Plan, or anyone else makes about your hospital stay and who will pay for it.
- Your doctor, your Plan, or the hospital should arrange for services you will need after you leave the hospital. Medicare or your Plan may cover some care in your home (home health care) and other kinds of care, if ordered by your doctor or by your Plan. You have a right to know about these services, who will pay for them, and where you can get them. If you have any questions, talk to your doctor or Plan, or talk to other hospital personnel.
Your Hospital Discharge and Medicare Appeal Rights
Date of Discharge: When your doctor or Plan determines that you can be discharged from the hospital, you will be advised of your planned date of discharge. You may appeal if you think that you are being asked to leave the hospital too soon. If you stay in the hospital after your planned date of discharge, it is likely that your charges for additional days in the hospital will not be covered by Medicare or your Plan.
Your Right to an Immediate Appeal without Financial Risk:
When you are advised of your planned date of discharge, if you think you are being asked to leave the hospital too soon, you have the right to appeal to your Quality Improvement Organization (also known as a QIO). The QIO is authorized by Medicare to provide a second opinion about your readiness to leave. You may call Medicare toll-free, 24 hours a day, at 1-800-MEDICARE (1-800-633-4227), or TTY/TTD: 1-877-486-2048, for more information on asking your QIO for a second opinion. If you appeal to the QIO by noon of the day after you receive a noncoverage notice, you are not responsible for paying for the days you stay in the hospital during the QIO review, even if the QIO disagrees with you. The QIO will decide within one day after it receives the necessary information.
Other Appeal Rights:
If you miss the deadline for filing an immediate appeal, you may still request a review by the QIO (or by your Plan, if you are a Plan enrollee) before you leave the hospital. However, you will have to pay for the costs of your additional days in the hospital if the QIO (or your Plan) denies your appeal. You may file for this review at the address or telephone number of the QIO (or of your Plan).
OMB Approval No. 0938-0692. Form No. CMS-R-193 (January 2003)
The phone number and address of the QIO for your area is:
South Dakota QIO
1323 South Minnesota Avenue
Sioux Falls, SD 57105