About Your Bill
Billing and Health Insurance can be confusing! At Tomah Memorial Hospital Patient Financial Services, we recognize this and our staff is here to help you and your family with your hospital billing questions. Please contact us if you would like to speak with someone about:
- An itemized listing of your hospital bill
- An explanation of your hospital bill
- Payment arrangements
Patient Financial Services Office Hours are
Monday through Friday, 7:00 a.m. until 5:00 p.m.
Voice mail may be left if we are provided with complete name and telephone number. Your call will be returned within 1-2 business days.
To direct your question to a representative:
| Self Pay Balances | Judy / 608.374.0354 |
| Insurance Patients, last name begins A-L | Nancy / 608.374.0334 |
| Insurance Patients, last name begins M-Z | Laurie / 608.374.0237 |
| Medicare | Diane / 608.374.0338 |
| Medicaid/Badger Care | Betty / 608.374.0333 |
In our continuing efforts to offer you easy and reliable access to help on your hospital billing questions, you can:
- Review our General Hospital and Billing Information
- Take a look at our Frequently Asked Questions
- Review our Glossary of common insurance terms to help you understand medical billing and insurance coverage.
Note: All information provided is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and/or consult your physician.
General Hospital and Billing Information
- Patient Responsibility
- Insurance and HMO Information
- Medicare
- Community Care
- Patient Balances
- General
- Physician Fees
When you seek services at Tomah Memorial Hospital, we ask that you accept responsibility for payment for those services in a timely manner. We will bill Medicare, Medicaid or your insurance for services provided. You will be required to sign a Consent for Treatment and Responsibility for Payment form regardless of third party insurance coverage. Your account is your personal responsibility. If any portion of your account is not covered by insurance, please contact Patient Financial Services to make other financial arrangements.
Tomah Memorial Hospital participates in many of the managed care plans offered in the area. If you have a question as to whether or not we participate in the plan you have, please check your provider directory or call your insurer.
It is very important for you to know if your insurance or HMO/PPO requires pre-certification for any care provided at the hospital. If pre-certification is required and you or your physician do not takes steps to insure this authorization is obtained, you will be responsible. Failure to obtain prior authorization can result in reduced benefits or the possible denial of your entire claim.
If you have insurance or HMO/PPO coverage, Patient Financial Services Office will bill your insurance if complete billing information was given at the time of registration/admission. You will be notified by letter if your insurance carrier or HMO/PPO does not pay the bill promptly or if there is a balance remaining after the insurance or HMO/PPO payment. If you have questions regarding payment, we suggest you contact your insurance carrier or HMO/PPO to review the status of your claim. If you have any other questions, please call Patient Financial Services.
TMH is a participating provider for Medicare and accepts assignment of covered benefits. After Medicare pays their portion of the charges, the hospital billing office will bill your supplemental insurance based on the information you provided during the registration process. You will receive a statement from the hospital notifying you of your responsibility if there are any balances after Medicare and your supplemental insurance payments.
Patients who are unable to pay for hospital service are welcome to apply for the hospital's Community Care program. Applications are available in Patient Financial Services, or by calling 608.374.0354. Eligibility is based on household income, family size, amount of medical debt and the financial resources of the household.
Federal poverty income guidelines are used as the basis for eligibility. The Community Care program involves only hospital charges. Some services provided by the hospital are not included in this program. In addition, physician’s fees from the clinics are not included in the hospital's Community Care program. If you wish to seek assistance with their bills, you will need to work directly with the physicians or their office staff.
If your insurance company does not pay in full, you will receive a statement notifying you of your balance. In addition to payment by check or money order, we do accept MasterCard, Visa, or Discover Cards. If you are unable to make payment in full, depending upon the balance due, the hospital may offer a short-term payment plan. You will need to contact Patient Financial Services at 608.374-0354 to work with them.
Delinquent accounts will be referred to outside collection agencies when payment in full has not been received or appropriate payments plans have not been established.
If you are pre-scheduled for a test or procedure and do not have insurance, you may be asked to pay all or a portion of the expected charges prior to the procedure with the balance of the charges due within 60 days after the procedure.
As a cost savings measure, we do not routinely send out copies of itemized patient bills. The statement you receive is a summary of charges. Should you desire an itemized statement, please contact Patient Financial Services and one will be sent to you within 2 business days. If you are a patient at the hospital multiple times, you may receive separate statements for each visit.
Your Hospital bill will not include charges for any physicians who provide services directly to you or on your behalf. Each physician involved in your care will bill you separately for services provided. The amount due to your physicians is in addition to your hospital bill. Questions concerning physician's fees should be directed to their billing offices.
Billing FAQs
Q. Why did I receive multiple hospital bills with the same account number?
A. If you have services that are billed on a monthly (unit) billing cycle, you may receive multiple bills with the same account number; however, they are for different periods of time.
Q. Why did I receive separate bills for the hospital and the doctor(s)?
A. These bills are for professional services provided by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, and other specialists perform these services may be legally required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you received from them.
Q. Will you bill my primary and secondary insurance?
A. You will need to provide us with complete primary insurance information. As a courtesy to our patients, Tomah Memorial Hospital submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.
Q. Are itemized statements automatically sent to patients?
A. No. We send summary bills to the patient. To request an itemized statement, call Patient Financial Services.
Q. Do you offer payment arrangements?
A. Yes, payment arrangements may be made by contacting Patient Financial Services at 608.374.0354.
Q. Why is this billed as an outpatient service when I spent the night in the hospital?
A. For an account to be billed as an inpatient service, there must be a physician order. The physician who ordered your services determined that your condition did not meet the requirements for an inpatient admission. The physician's written order dictates whether we bill as an inpatient or outpatient.
Q. Why am I receiving a refund check?
A. There was an overpayment to your account. Either you paid too much on the account and/or your insurance paid at a later date and covered some of what you already paid.
Q. Why did my insurance deny the claim?
A. One or more of the following may apply:
- The service you received was not covered under your plan
- You did not provide the correct insurance information at the time of service
- The service you received was from a physician outside your plan's network
- You were not covered by your plan at time of service
- Your primary care physician did not process a referral for the services or an authorization was not obtained prior to the services being rendered.
Q. Can I come in and talk to someone regarding my bill?
A. Yes, our Patient Financial Service Representatives are here to assist you from 7:00-5:00 Monday - Friday.
Q. Must I register each time I come to the hospital?
A. Yes, information gathered from patient registration is stored in our computer system. We retrieve this information each time the patient returns for services and we ask the patient to verify that the information is current and accurate. Medicare requires that specific questions be asked to determine whether Medicare or another payor is primary. Your assistance in verifying the information is always appreciated. Information may be obtained prior to the service, eliminating a stop at the registration office.
Q. I don't have any insurance. Is there any help available?
A. We can assist you in several ways: we have financial counselors who will assist you with information on programs that may be available to you or will give you advice on how to proceed. If you do not qualify for any type of Government programs, we can review your financial status to see if you qualify for Community Care.
Q. I come to the hospital often. Is there any way that I can receive one bill?
A. Unfortunately, because of insurance requirements, we may be required to bill each visit separately.
Q. Why is there an error on my bill?
A. If you have questions about your bill, or believe that it is incorrect, call Patient Financial Services Monday-Friday 7 a.m. - 5 p.m. Confidential voice mail is available after hours, and every attempt will be made to return your call by the next business day.
Q. What is a co-payment?
A. A co-payment is a set fee the member pays to providers at the time services are rendered. Co-pays are applied to emergency room visits, hospital admissions, office visits, etc. The costs are usually minimal. The patient should be aware of the co-payment amounts prior to the date of service.
Q. What is a deductible?
A. Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are paid. For example, if a member's policy contains a $500 deductible, the member must accumulate and pay $500 out of pocket before the insurance carrier will pay benefits. Once the patient has met their deductible, the carrier usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are yearly, usually starting in January.
Q. What is co-insurance?
A. Co-insurance is a form of cost sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.
Q. Why did my insurance company only pay part of my bill?
A. Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Please contact your insurance company for specific answers to your questions. You may have out-of-pocket expenses.
Q. Why do I need to call the insurance company if they do not pay the bill?
A. If you have an insurance policy, you are ultimately responsible for the total bill or any portion of the bill your insurance carrier does not pay. Your insurance is a contract between you and the insurance company.
Q. If I have an HMO policy, can I be billed if they do not pay?
A. If you have an HMO policy, you should only be billed for the amount specified on your explanation of benefits (EOB) that is provided to you by your insurance carrier. This usually includes co-pay amounts, deductibles and non-covered services.
Q. I belong to a managed care plan. What should I do before coming to the hospital?
A. Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process; if you receive a verbal authorization number, please provide us with this information at registration.
Q. I belong to a managed care plan but needed to be seen in the emergency room, what should I do now?
A. After receiving services, if you did not contact your primary care physician or your insurance plan before you came to the emergency room you will need to contact them within 24 hours explain the circumstances and ask for authorization.
Insurance Glossary
Assignment of Benefits: The transfer of the right for payment of insurance benefits to be paid directly to the health care provider of service.
Birthday Rule (COB): Used to determine primary and secondary coverage for children. The word "birthday" refers only to the month and day in a calendar year, not the year in which the parent was born.
- If the parents are not separated/divorced, the insurance of the parent whose birthday occurs first in a calendar year is considered the primary insurance while the other parent’s benefits are considered the secondary coverage.
- If the parents have the same birthday, the insurance plan that has been in effect for the longest time is considered the primary insurance.
- If the parents are separated/divorced and there is more than one insurance plan covering the child, the primary insurance is determined in the following order:
- The insurance plan of the parent with legal custody of the child
- The plan of the spouse of the parent with legal custody of the child
- The plan of the parent who does not have legal custody of the child
There can be some exceptions depending on a court decree. If there is no specific terms in the court decree (stating only that the parents share joint custody), the benefit determination would be the same as if the parents are not separated or divorced, the insurance of the parent whose birthday occurs first in a calendar year is considered the primary insurance while the other parent's benefits are considered the secondary coverage.
Co-insurance: The percent of your medical bill benefits you are expected to pay as determined by your health insurance carrier.
Contractual adjustment: The difference between the insurance company’s contracted rate of payment with the provider and the amount of the charge.
Coordination of Benefits (COB): A group policy provision which helps determine the primary carrier in instances where the patient is covered by more than one insurance policy.
Co-payment: The amount you are expected to pay (such as amount for each physician visit or prescriptions) as determined by your health insurance policy.
Deductible (DED): The amount the insurance company assigns as patient liability prior to their calculation of the insurance payment amount.
Explanation of Benefits (E0B): An explanation of insurance payment, adjustments and any residual balance of claim processing sent to the insured and provider of service by the insurance company.
Guarantor: The person financially responsible for paying for the patient's medical bills.
Health Maintenance Organization (HMO): Health care plans where the member is assigned or chooses a PCP who manages their health care. The PCP must provide the care or authorize any specialty services in order for the services to be paid. Under these plans, the patient is typically responsible for only their co-pays as long as the services are PCP approved.
Managed Care: An insurance managed medical delivery system that manages the quality and cost of medical services.
Medicare: A federal insurance program for individuals age 65 and older, as well as younger disabled or dialysis patients. Medicare Part A covers in-patient hospital services, nursing home, home health and hospice care. Part B covers outpatient hospital services, physicians' services, medical equipment and supplies and other health services and supplies.
Medicare Supplement: A private insurance policy to help pay the balance of covered charges after the Medicare benefits payment.
Non-covered services: Charges/services that the insurance company determines is a cost that they do not consider for payment. These charges/services are normally the responsibility of the patient/guarantor to pay.
Out-of-Network (OON): Most managed care insurance plans are contracted with a specific group of health care providers of service. If a patient requests health care outside this specific provider group with a provider not contracted to provide care, the patient/guarantor may be financially responsible for some or all of the cost of the care received, depending on the determination made by the insurance carrier. Normally, exception is made to this rule for emergency medical care.
Preferred Provider Organization (PPO): Health care plans that allow the patient to direct his own healthcare. The patient can self-refer within the network of contracted providers. He will be responsible for deductible and normally a percentage of the allowable benefit amount. The patient may choose to go outside the PPO network to receive care and be responsible for higher deductibles and out-of-pocket amounts. The patient is also responsible for obtaining authorizations for some types of services.
Primary Care Physician (PCP): Many insurance plans require members to choose or be assigned to a PCP, who is responsible for providing or authorizing all medical care for the patient.
Prior Authorization/Pre-certification: Advance formal approval required by the insurance company prior to medical services being rendered. The insurance company approves services based on their determination of medical necessity, appropriateness, and other pertinent factors. Emergency services are not prior authorized, but in most cases must be reported to the insurance company within twenty-four (24) hours.
Referral: A physician's medical order for consultations/services for the patient with a specialist.
Self-Pay (Private Pay): Patients who do not have insurance or those who are not approved to seek services at a particular health care provider are considered a self-pay patient who is expected to pay for the medical services they receive.
Subscriber/Insured: The person who is enrolled for benefits with the insurance company, either under group plans, private policies or governmental agencies.
UB92 and 1500 Claim Forms: Federally mandated insurance claim forms used to bill medical bills to insurance payer. The UB92 form is used for hospital /clinic technical charge billing. The 1500 claim form is used for physician professional charge billing.
Workers Compensation: Insurance coverage provided by an employer to pay for health care services resulting from work-related injuries and illnesses.
