BILLING SERVICES

Scheurer Health participates with the following Medicare plans:

• Medicare // Traditional
• Aetna Medicare
• Medicare Plus Blue
• Blue Care Network Medicare
• Humana Medicare
• HAP Medicare
• Priority Health medicare
  • effective: Nov 01, 2020

Scheurer Health participates with the following Medicaid plans:

• Medicaid // State of Michigan
• McLaren
• Meridian
• Molina
• United HealthCare Community Plan

Scheurer Health participates with the following Commercial plans:

• Aetna
• ASR Health Benefits
• Cofinity
• Coventry
• Curanet
• HAP
• Humana
• McLaren
• Mail Handlers Benefit Plan
• Multiplan // Hospital-only, not Physicians
• Priority Health
• Three Rivers Provider Network // TRPN
• UnitedHealthcare
• Workman's Compensation

Scheurer Health participates with the following BCBSM plans:

• Blue Cross Blue Shield of Michigan // BCBSM
• Blue Care Network
• BCBSM // Federal
• Anthem BCBSM

Scheurer Hospital offers a Financial Assistance Program to individuals who are not insured or have a high co-pay or deductible and are not financially able to pay for their required medical treatment.

Application process

• Contact a Patient Financial Advisor at 989.453.7301 or 800.690.9972.
• Complete the application.
• Submit the completed application and all required documents to the Patient Financial Advisor.
• Patient Financial Advisor and committee members will review the application and submitted documentation and determine eligibility.
• You will be notified by mail with the amount of your assistance.
• Future bills will have to be submitted to the Patient Financial Advisor to be adjusted according to your financial assistance terms.

Required documentation

• Proof of income: Public assistance, social security, unemployment/worker's compensation, strike benefits from union funds, veterans benefits, training stipends, alimony, child support, military family allotments, pensions, interest, dividends, rent, income from estates and trust wages or any other source of income
• Income tax return: Most current year
• Assets: Recreational vehicles (boats, ATVs, etc), cars, trailers, land
• Monthly expenses: Rent/mortgage home or land utilities (electric, heat, telephone, water), insurance (house, car, medical, renters, life, COBRA), child support, child care, credit card payments, property taxes, medication, tuition, and any other applicable monthly expenses

Scheurer Hospital is proud of its Financial Assistance Program. As a provider of high quality healthcare services, Scheurer Hospital recognizes a religious, moral, and social obligation to provide financial assistance to any patient who demonstrates the inability to pay, regardless of race, color, national origin, sex, or physical handicap.

For more information, please contact us at 989.453.7301 or 800.690.9972. Our office is open Monday through Friday from 8 a.m. to 4:30 p.m. We are located at 108 N. Caseville Road, Pigeon, MI, a block south of Scheurer Hospital and across from Self Serve Lumber.

Medicare patients will sometimes get a bill for medication that is given to them when they are in the emergency room or are held over for observation. They are receiving this bill because Medicare has determined that certain drugs can be self-administered (the patient can give them to themselves) and therefore they have ruled that they will not pay for them. Medicare explains this rule in your Medicare and You handbook, but it is not really all that clear.

Medicare defines self-administered drugs as:

• Oral tablets
• Creams
• Medicine patches
• Capsules
• Lotions
• Suppositories
• Liquids
• Ear products
• Eye products
• Insulin
• All inhalers

The policy at Scheurer Hospital for self-administered drugs is that you are allowed to bring your own medications from home, but they:

1. Must be in their original container.
2. Must be properly labeled.
3. Must be what you need to have from your doctor during your stay.

If these criteria are not met, your doctor will give you what he/she thinks is necessary for your care during your stay. You will get a bill for these self-administered drugs because Medicare won't cover them.

While we know this is a concern because of the added expense to some patients, we are obligated to follow Medicare rules. We will continue to help you in any way possible by answering your questions about Medicare's rule on self-administered drugs.

Has this ever happened to you? Have you ever had to call the billing department and ask why you got a bill for something that you thought your insurance should cover at 100 percent? A lot of insurance policies offer benefits for wellness and screening but don't give you all the details on how you can receive them.

Please realize that "100 percent coverage" only applies to your claim if you are receiving exactly what the insurance is describing in your policy for that benefit.

To find out what you are entitled to, call your insurance company (before you have your lab work, test, mammogram, procedure, etc., done) and ask what your benefits for screening are. Tell your insurance company exactly what your doctor has ordered for you and also give them all of the diagnoses that your doctor has put on your order. Your order may contain both screening and diagnostic tests with screening and diagnostic diagnoses on it, depending on what you saw your doctor for, and it is important to know which test corresponds with which diagnosis.

• Some policies hold you to a deductible/co-insurance for these kinds of services.
• Some policies require you to have only a screening diagnosis on your claim.
• Some require only certain types of lab work or tests to be done in order to be covered at 100 percent.
• Some policies have a $250/$500 maximum for preventive services.

Keep in mind that the law requires your billing to include only the test/procedure that you had done along with the diagnosis that your physician has given. Your physician must have proper documentation in his chart to back up anything he orders. The claim should not be altered once your service has been performed, or this would be considered fraudulent—so it is wise to check on your coverage before any testing is done.

It is also reasonable to know that if you are having a screening procedure (such as a colonoscopy) and your doctor finds something during that procedure that he/she needs to treat at that time, your claim then turns from a screening to a diagnostic, and the benefit for that usually will not be covered at 100 percent. Diagnostic claims are paid with your deductible, and co-insurance is applied to them.

Getting educated about your health insurance policy and what coverage you have for screening and wellness benefits will save you a lot of misunderstandings when you receive your statement in the mail. We at Scheurer Hospital are always ready to help you with any questions you may have.

A lot of insurance companies are changing their policies and are requiring their policy holders to become more involved in filing their medical claims. One of those changes is pre-authorization.

More and more insurance companies are asking that their customers notify them before they are scheduled by their doctor for certain types of high-dollar tests or procedures. The insurance company can issue a penalty to the patient if their rules for pre-authorization are not followed.

A pre-authorization number that will be placed on your claim when it is billed can usually be obtained through a phone call to your insurance company. They may ask you some personal questions, such as your name, date of birth, policy number, name of the test/procedure you will be having done, the reason why you are having it, and the ordering physician's name. After answering their questions, you will be issued a number that you will then report to your hospital/facility so they can put it on your claim to the insurance company.

A pre-authorization number is very important. You will want to be sure to check your policy to find out if one is required for any of your important testing. It is imperative to have this authorization, if one is required, in order to get your claim paid properly. Your physician's office can usually assist you with the information that you need to tell the insurance company.

If you have any health insurance claims since January 1st, you may have seen a larger balance due on those bills. This is because your yearly deductible starts over each calendar year and is first applied to your claims before your other benefits (co-insurance, etc.) will kick in. Do you know what your deductible is? Is it $250? $500? $1000? Whatever the amount is, this is the agreed amount that you and your insurance company had set up when you purchased your policy. You should refer to your health insurance handbook, talk to your employer, or call the phone number on the back of your insurance card to find out what your deductible is so that you can be prepared when this expense arises.

Not only are you responsible for your yearly deductible, but most insurance policies also apply a percentage of the remaining allowed amount to your balance. This is called your co-insurance. Most policies have an 80-20 percent co-insurance, which means your insurance covers 80 percent of the allowed charges after your deductible is met and you would be responsible for paying 20 percent. Other policies have a 90-10 percent co-insurance and yet others have 70-30 percent or none at all.

If you have ever had a doctor's appointment, then you are familiar with a co-pay. This is a set amount that your insurance requires that you pay at the time of your service (e.g., an office visit or walk-in clinic or an emergency room visit). Your co-pay will be a certain amount, such as $20, $25, $30, $50, etc. Check your policy to be sure what it is.

No matter what the balance on your insurance bills says, you should educate yourself with what your personal policy covers and what you will be responsible for so you are not surprised when you get your bill from any medical provider.

As always, our Scheurer Hospital billing staff is here to answer any insurance questions you may have and can be reached at 800.690.9972.