At The Orthopedic Hospital, our goal is to provide you with high-quality care and the best possible experience, from registration to discharge. Healthcare billing and insurance is complex and varies based on your insurance plan. We know patients are most interested in understanding how much they will pay out of pocket. Our team members are available to help you understand your health insurance benefits and your share of the financial responsibility for the services we provide. Please visit the Patient Access Department, call a member of our team at (260) 479-3122, Monday through Friday, or email us at PatAccEducation@lhn.net to obtain a personalized estimate for services.
Things to Know When Determining Your Financial Responsibility
We accept most insurance available in our community, including Medicare and Medicaid.
For patients with health insurance through your employer, individual insurance marketplace or the healthcare exchanges:
- Commercial insurers negotiate rates with hospitals on behalf of their members. The rates vary among insurers.
- Several factors can affect the amount a patient owes to a hospital, including the type of plan you have, the amount of your insurance benefits require you pay for co-pays, deductibles and co-insurance.
- Generally, the amount you pay will be less if your hospital and physicians are in-network with your health plan.
- Be sure you review your benefits plan to understand all of the factors affecting your financial responsibility.
For patients with Medicare & Medicaid:
- The government determines how much it will pay a hospital for services provided to Medicare and Medicaid patients. The government also determines a Medicare or Medicaid patient's out-of-pocket payment amounts (deductibles and coinsurance), if any.
- Medicare Part A generally pays for inpatient hospital services. Some other services received in the hospital, such as physician services, and emergency and outpatient care may be paid by Medicare Part B. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare to provide both Part A and Part B benefits. Medicaid programs are required to cover all inpatient and outpatient services, among other things.
For individuals who do not have insurance, carry out-of-network insurance, or who receive services their insurance does not cover:
- Our hospital offers a variety of financial assistance programs, including charity care, prompt pay discounts, and generous self-pay discounts for uninsured individuals.
- We also provide eligibility screening services that can help identify the availability of resources to cover medical services, such as Medicaid.
Our patient access staff is available to help you understand your health insurance benefits and your share of the financial responsibility and give you an estimate for the cost of services we provide. So that estimates are as accurate as possible, please provide:
- Detailed description of the test(s)/procedure(s) being ordered by the doctor,
- Doctor's name and phone number, and
- Insurance information (if any), including insurance company name and phone number, policyholder name, policy number and group number located on the insurance card.
The hospital estimate will provide the following:
- The estimated financial responsibility for the procedure/services based on the standard charge for the procedure/services.
- Patients with health insurance will be quoted an estimated amount that will be due to the hospital based on deductible, co-pay or co-insurance amounts established by their health insurance plan.
- Patients who do not have health insurance will be quoted an estimated amount due to the hospital that will include an uninsured discount to the estimate.
- Patient Access staff is also available to discuss with patients their eligibility for certain programs like Medicaid.
Estimates do not include any services related to complications that may occur during the procedure/services. Also, charges for physician fee such as a surgeon, pathologist, anesthesiologist or radiologist will not be included. These charges will be billed separately by the specific provider. Due to these factors, estimates are not exact and cannot be interpreted as a bill or exact costs for services.
About Hospital Charges
Hospital charges vary from facility to facility for many complex reasons including each hospital's unique mix of services and payer relationships. The government requires hospitals to maintain a fee schedule, commonly known as the chargemaster, and to publish the chargemaster on their websites. These charges do not reflect what patients generally pay for the services they receive or represent what the hospital is actually paid in most circumstances. The chargemaster should not be used to estimate a patient's actual cost of care or as a meaningful comparison about what hospitals are paid for their services.
We encourage all patients – regardless of insurance status – to contact us in order to obtain a cost estimate, information about our financial assistance programs, or a better understanding of their insurance coverage.