Hospital Pricing and Charges
Nemaha Valley Community Hospital understands that coming to the hospital can be a stressful time and the bill associated with your care can be complex and difficult to understand. We are committed to providing our patients and family members with information to help understand our hospital pricing and charges.
What You Should Know When Looking at Charge Information
As the healthcare system has become more complex, so have the costs charged directly to the patient. The amount you may pay depends upon a number of factors, and we want to be sure you are always kept informed and help you manage your healthcare costs.
- “Charge” is not the same as what you may owe. “Charge” is the amount billed for a service.
- All professional charges (surgeons, radiologists, pathologists, visiting specialty providers and etc.) are billed separately and are not included in the charges shown.
- Because each person’s health needs are different, the charges shown will depend on the individual’s specific situation, each patient’s circumstances are different.
- If you have Health Insurance: Health Insurance will pay for many of your health services, but not all of them. If you have questions begin by contacting your insurance company to understand your insurance policy’s deductible, co-payment, coinsurance and maximum out-of-pocket levels. To avoid out-of-network penalties, check to see if you are required to use hospitals that are in your insurance company’s network. In addition, ask if you need to obtain pre-certification or referral approvals prior to your hospital service. This will help you avoid your policy’s penalties and additional amounts owed when the required approval is not obtained. Some insurance companies negotiate discounts with hospitals on behalf of the patients they insure. The discounts will vary among insurance companies.
- If you have Medicare: Medicare will pay for many of your health services, but not all of them. Medicare does not pay hospitals based on charges, but instead pays according to pre-established rates depending on the services you receive. Your Medicare deductibles and coinsurance are also pre-established based on the services you receive. If you have a Medicare supplemental insurance policy, it may pay all or a portion of your Medicare deductibles and coinsurance. Special rules apply if you or your spouse has health insurance coverage through your employer. Special rules also apply if you have coverage through a Medicare Managed Care plan. Contact your Medicare Managed Care plan to understand your deductible, co-payment, coinsurance and maximum out-of-pocket levels. To avoid out-of-network penalties, check to see if you are required to use hospitals that are in the Medicare Managed Care plan’s network. For contact and additional information please visit Medicare at: http://www.medicare.gov/.
- If you have Medicaid: Kansas Medicaid has Managed Care Plans. Medicaid will pay for many of your health services, but not all of them. Medicaid does not pay hospitals based on charges, but instead pays according to pre-established rates depending on the services you receive. A few services have minimal pre-established co-pays that are your responsibility to pay. Co-pays will not apply if you are in a Medicaid Managed Care Plan.
- If you are Uninsured: If you have a financial need, a variety of financial assistance options are available that may help pay all or a portion of your hospital charges. In some cases, you will be asked to provide income and other asset information to determine whether or not you qualify for full or partial financial assistance. To obtain more information, please call our hospital’s Business Office at 785-336-6181 or click here for an application.
After your procedure or discharge from the hospital, you will receive a hospital bill for services and care you received from the hospital during your procedure or stay. You may receive separate bills from other physicians that provided care/services during your procedure or hospital stay.
If you have health insurance, we will bill your insurance company directly. Typically, you will receive an explanation of benefits (EOB) from your insurance company. This will show a summary of services billed directly to your insurance on your hospital bill.
The EOB from your insurance company will explain what the insurance company paid the hospital for your care, or what it declines to pay. You may receive a bill for expenses not covered by your insurance company, such as co-pays, deductibles or co-insurance. If you have any questions about your hospital bill, please contact our Business Office at 785-336-6181.
If you have health insurance, there is a good chance we will be able to provide an estimate of your out-of-pocket responsibility. Availability of this service is dependent on your insurance company being able to provide us with up to date benefit information prior to your service. For the most accurate information, check with your insurance company on your coverage.
This list of charges reflects the standard charges for inpatient and outpatient services provided at Nemaha Valley Community Hospital. It is important to note that the hospital’s list of charges is the same for all patients but each patient’s circumstances will determine what is required for their care. A patient’s financial responsibility for services provided may vary, depending upon payment plans negotiated with individual health insurers as well as reimbursement schedules set forth by public payers such as Medicare and Medicaid. Patients should contact our Business Office at 785-336-6181 for assistance and additional questions. These charges do not include items or services that may be billed separately for visiting specialty physician services, lab, diagnostic services, etc.
Presumptive Eligibility (PE): The State of Kansas Presumptive Eligibility Medicaid coverage allows health care providers to treat an individual who is not enrolled in the KanCare Medicaid program. It provides consumers with temporary medical coverage. In order to be found eligible, an individual must have an application submitted for them by a Certified PE worker during their stay at a Qualified Entity. Individuals will be notified immediately of their eligibility determination and must follow up their Presumptive Eligibility application with a KanCare application for full Medicaid coverage.