I can't pay my bill. What can I do?
Memorial has a team of people that will help you find out which programs you qualify for. If you have any questions about these programs, please call us at (954) 276-5760.
I am getting bills from doctors I never saw. Why?
Your physician will order tests that require a specialist to review to give your physician guidance in your healthcare plan. Some of the specialists that will work with your physician are the radiologist, pathologist, and other consulting physicians. Memorial cannot guarantee that these physicians are part of your insurance network.
I stayed overnight in the hospital but you billed my insurance company as an outpatient. Why?
Insurance companies, even Medicare, have specific requirements before we can bill a service as an inpatient. These companies use specific guidelines based upon your current clinical situation to determine if they will pay for your service as an inpatient or outpatient. In addition, your physician must order that you are an inpatient or outpatient similar to when they order lab tests that they want performed. Staying overnight does not automatically mean that you are considered an inpatient.
I have Medicare and a second insurance that covers what Medicare doesn't pay, why are you sending me a bill?
Memorial accepts Medicare assignment. We will only bill you for the services that Medicare states are your responsibility to pay. Once Medicare sends a payment to Memorial we will send your bill and the Medicare Explanation of Benefits (EOB) to the second insurance plan that we have on file. We will wait for 90 days for your second insurance to pay. After 90 days, the remaining bill becomes your responsibility. If your second insurance doesn't pay for all of your approved patient responsibility, we will send you a bill for the difference.
You say Medicare will not cover this service. What can I do?
Medicare has many specific coverage restrictions for outpatient diagnostic services. In addition, utilization limits have been established by Medicare for certain services, which restricts the amount of times those services can be provided yearly. Before these services are provided, you will be asked to read and sign an Advance Beneficiary Notice (ABN) that explains why Medicare may not pay for your service. By signing the ABN, you assume financial responsibility in the event Medicare denies payment. Non-covered services, which include, but is not limited to, screening exams, preventive medicine services and eye refractions, do not require prior notification and are not subject to ABN requirements. Please call Medicare if you have questions about coverage.
You are not listed as a participating provider for my insurance. Can I still use your hospital?
It depends on your coverage. If your plan is a replacement for Medicare or Medicaid or an HMO then we can only provide emergency room services. If you have an employer PPO plan then you can use our services but you will have a higher deductible and co-insurance to pay than if you went to a participating provider.
What happens if I forget my authorization information on the day of service?
Your insurance company will not pay us if we do not have an authorization. If we are unable to confirm your authorization, we will reschedule your service to another date and time so that the authorization can be obtained.
My insurance company paid you but they used "Usual and Customary" charge amounts. You are billing me for the difference. Why?
Most health plans have developed their own fee schedule for medical services. This amount is typically called "Usual and Customary" or "UCR" charges. Our charges reflect the cost of services deemed medically necessary for you based on the examinations and evaluations performed at Memorial. Unless you are covered by a plan that participates with Memorial, it is likely that your charges will differ from your health plan's allowable amount. You are responsible for your charges in full, regardless of your plan's level of reimbursement, and it is very important you understand what your plan pays.
How do I know my charges are correct?
You will receive a statement that gives a summary of your charges. You can request an itemized bill if you wish to review the individual charges on your account. If you think there is an error, please call our patient financial services team at (954) 276-5501 and request that an audit be performed on the charges you think may be incorrect. A nurse will review your medical record and confirm that the documentation supports the charge. If the nurse does not find any supporting documentation, the charge will be removed from your account.