Billing and insurance
The bills you receive after an extensive healthcare experience can be confusing. Many people contribute to your care and may send you separate bills. This would include bills from your doctor or any specialists that were involved in your care.
Financial counselors are available to help provide you with a pre-service estimate*, help you understand your hospital bill and make the payment process more manageable. You can call us Monday through Friday, 8 a.m. to 4:30 p.m., at 541.274.6699.
*Estimates are based on the scheduled service/CPT codes provided and may not include some services which are billed separately, such as an anesthesiologist, outside labs or doctors that bill separately from Sky Lakes Medical Center. There also could be the potential for out-of-network charges with your insurance, and you may need to verify that information with your insurance carrier. If you have an out-of-network provider, it is our standard of practice to welcome them to contact patient financial services directly to negotiate the rate for services provided.
Medical billing information
Sky Lakes Medical Center will bill your primary and secondary insurances for you. You will not receive a bill from us until your insurance company has finished paying its portion of your claim. When you do receive a bill, it will reflect the amount due by you for services rendered by Sky Lakes Medical Center. It should be saved for future reference. When calling or writing about your account, please refer to your account number, which is indicated on your bill. Any charges or payments posted after the date of your bill will appear on your next statement.
Patients with insurance coverage
Insurance is designed to help you meet the cost of medical services. If you gave us all the requested information, including a copy of your insurance card, we will submit a claim to your insurance company as a courtesy to you. However, your insurance is a contract between you and your carrier or employer. Therefore, the ultimate responsibility for payment rests with you. It is our hospital policy to allow 45 days from the billing date for your insurance to pay. If they have not paid within 45 days, you will be responsible for payment of the balance due.
Patients with workers' compensation
If your hospital visit was work-related, we will not bill your employer. You should obtain the workers' compensation carrier information from your employer and provide it to us. Unless we have that information, your account balance will be due by you. If you direct us to bill your health insurance rather than your workers' compensation carrier, we will allow 45 days from the billing date for your insurance to pay. If they have not paid within 45 days, you will be responsible for payment of the balance due.
Ayuda Para Pagar Su Cuenta o Factura. Si usted tiene alguna pregunta por favor póngase en contacto con nuestros asesores financieros al 541.274.6699. Nuestra oficina está abierta de 8am-430pm - Lunes a Viernes.
Ensuring accurate billing
Here are a few things you can do before your visit to ensure accurate billing:
- When scheduling your appointment, pre-register, and make sure the correct information is in our billing system.
- Be aware that your provider has obtained any pre-certification or referral from your insurance company if necessary.
- Understand your insurance coverage.
- Make sure the hospital accepts your insurance plan.
- Review information on your insurance company's website.
- Make sure you have a good understanding of what is and is not covered by your plan.
- Ask questions.
- Get contact information for financial questions you may have after your visit.
Accepted insurance plans
Sky Lakes Medical Center and its associated clinics accept a variety of commercial health insurance, workers' compensation, Medicaid and Medicare plans.
Please verify plan acceptance and participation with your provider, your physician or other health service provider.
For more information, call 541.274.6221.
Sky Lakes Medical Center accepts all Medicare standard supplemental insurance policies.
Please provide a copy of your card at the time of service. We will bill the Oregon Health plan as well as our border states. If you have coverage in another state, please call our office and verify our participation. If you have a share of cost or co-pay, it will be expected at the time of service.
When filing an appeal for insurance denials:
- You should keep a record of all letters that you receive and a log of all telephone calls that you make or receive related to the denial. Be sure to write down who you spoke to and the date.
- Get a copy of the denial letter. This should give a specific reason for the denial. If you have Medicare, look at your Medicare Summary Notice. Find item 10—non-covered charges.
- Call patient financial services, 541.274.6221, and request a copy of all information that was submitted to your insurance.
- Call your insurance company and get a copy of your plan document (policy), plan summary or health insurance booklet. If you have Medicare call 800.MEDICARE and request a "Medicare and You" booklet.
- Get specific names and telephone numbers of contact people. You may have to call your insurance company and ask for a contact person. Be sure to get their direct line. Get the address where you send your appeal; this may not be the same address for the initial claim submission. Also have someone at the physician's office or facility that will help you with the appeals process.
If you have Medicare, remember you always have the right to appeal decisions that deny or limit payment for medical care. Consult the back of your Medicare Summary Notice for more information about your appeal rights. Private insurance will have a written process you must follow to appeal the denial. You may find this in the plan document, it may be on the denial letter, or you may have to request this from the insurance company.
If you still do not understand your rights or the appeal process is unclear, and your employer or insurer will not or cannot explain further, it may be helpful to contact an attorney.
- Read your policy before you file an appeal to ensure you understand your coverage.
- Find out why the claim was rejected. Follow the appeal process outlined by your health plan. You may need to get a letter from your doctor/specialist addressing the specifics of your case. You may need to write an appeal letter and include copies of your medical records.
- Be sure to follow all time limits that are outlined in the appeal process for your health plan. Timely follow-up can make all the difference in the world.
- When writing your appeal letter, indicate the date, claim number, date of service, your member identification (subscriber) number, group or policy number, amount of charge, and medical provider name.
- Don't give up. If you receive a second denial, you may consider continuing with the appeal process. Most plans have several levels of appeal.
- Keep copies of all documents that you submit to the insurance company. You also might send the documents by registered mail, return receipt requested.
In some cases it may be helpful to contact an attorney. Many people would rather appeal the denial on their own to see if they can overturn it without legal help and expense. It may also depend on the cost of the procedure. Your state or local representative may also provide assistance in resolving insurance issues. You may access a list of legislators at the National Patient Advocate Foundation website. It may also be beneficial to contact the State Department of Insurance. One of the main duties of the insurance commissioner is to make sure the health plan is following the patient's policy.
Since each insurance is different, it is impossible to write a fail-proof plan for overturning a denial. Reviewing your plan policy, documenting your conversations and actions, and staying organized and focused all will assist you in obtaining the outcome you desire.