Insurance Questions

What does in-network mean to me?

To receive full insurance benefits, some insurance companies will require patients to receive services from an "in-network" or "participating provider".

Contact your insurance company and ask them if Regional Medical Center, Delaware County Memorial Hospital, Regional Family Health, Regional Medical Home Care, or Regional Medical Center Hospice is in their network. If they do not find us in their “in-network” system by any of the above names contact us.

Why should I bring my insurance card and a picture ID with me to my appointment?

A copy of your insurance card, picture ID, and the forms you will sign at registration are needed to file a claim to your insurance company. Without correct and complete information, your insurance company cannot pay for your visit.

Will you file worker’s compensation, motor vehicle accident, or medical liability claims for me?

Yes. We will bill any of these claims as long as you provide us with the correct information. Please file a “First Report of Injury” with your employer.

Do I need to let my insurance company know that I’m going to be in the hospital?

You should check with your insurance company or employer to determine notification requirements and what is or is not covered by your insurance plan. There are many different insurance plans; typically our staff does not know whether a specific service will be covered.

How do I know if my insurance company will cover my visit or certain services?

Medically necessary, preventive care, and appropriate services may not be covered by your insurance company. There are many different insurance plans; typically our staff does not know whether a specific service will be covered. Refer to your insurance handbook or call your insurance company with questions prior to your appointment. That phone number can be found on the back of your insurance card.

How do I know if my insurance company will cover services provided by all professionals (i.e. CRNAs, radiologists, and pathologists)?

Each professional or specialist needs to contract individually with insurance companies. Check with your insurance company or employer about coverage prior to receiving services.

How do I follow-up with my insurance company?

Call the insurance company by referencing the phone number on the back of your insurance card; have ready your insurance card, date of service, facility name, billed amount, patient name, and claim number. Ask for the status of the account. If it has been paid, ask when and to whom. If it has not been paid, find out when they expect to pay and if they need anything from you. Write down the information you are given as well as the name of the person you spoke with at the insurance company. If the bill does not get paid in the time frame they gave you, follow-up with the insurance company again.

How will I know if my insurance company has paid my bill?

Each insurance company mails an Explanation of Benefits (EOB). This will explain what was paid or not paid by them and why. If there is a balance due, to be paid by you, after the insurance company has paid its portion, we will send you a bill that will indicate the amount that has been paid and any balance you need to pay.

What do I do if I disagree with how much my insurance company has paid on my bill?

Contact the insurance company and ask how your claim was processed. If the insurance company finds an error was made, write down the information you are given as well as the name of the person you spoke with at the insurance company. Request an anticipated payment date. If the bill does not get paid in the time frame they gave you, follow-up with the insurance company again.

If the insurance company feels the bill was paid correctly and you still disagree, ask them what you need to do to file an appeal. Filing an appeal will not guarantee they will pay more on your bill, but the claim will be reviewed for reconsideration. If you plan to make an appeal, ask them what information needs to be provided for you to complete this.

Will my insurance pay for preventive services?

Contact your insurance company to check on your policy benefits for these types of services. Many insurance plans do cover preventive screening services at 100% with no cost to you. Please note that we are required to code and bill your medical claims compliantly. If you are actively seeking treatment or on medication for a certain condition (i.e. high cholesterol), we cannot code services related to this condition as a screening service. We must code and bill your claims based on the documentation found in your medical record.