about your bill
Because we understand that hospital bills can be confusing, we have included the following information to help you understand the process. If you have any questions or need to make arrangements for paying your bill, you may contact the representative who will handle your inpatient account during your stay. He or she can be reached Monday through Friday from 8:00 a.m. to 4:00 p.m. by dialing ext. 5120. For questions pertaining to your outpatient bills, call 845-368-5152.
Who decides how you will be charged?
You may be surprised to learn that the answer is not Good Samaritan Hospital. In most cases, the amount you will be charged for services is determined, not by the Hospital, but by governmental regulations and contractual agreements with insurance companies. Medicare, Medicaid, No-fault and Workers Compensation all determine both the amount the hospital will be paid and the amount a patient will be responsible for paying, based on the patients DRG. In the case of HMOs, co-payments and deductibles are determined by a patient's particular contract.
How the DRG system works
All illnesses and injuries are categorized into more than 500 diagnosis related groups (DRGs). The State has determined a payment rate and length of stay for each DRG, based on the average amount of services used by all of our patients in the same category. While rates vary from DRG to DRG depending on the severity of the condition, all patients in one DRG must be charged the same amount.
During your stay, Good Samaritan Hospital's Case Managers review your records, as required by law, to make sure all federal and state guidelines for continued hospitalization are met. They will also work with your physician to assure the best use of our services.
As a service to you, Good Samaritan Hospital will submit your claim for payment directly to Blue Cross, Medicare, Medicaid, no-fault carriers, workmen's compensation carriers and all commercial insurance companies, provided you give the necessary insurance information at the time of your registration or admission.
If your insurance company requires completed claim forms, please be prepared to provide these upon registration or, if necessary, arrange for a family member to bring these forms, along with your insurance ID cards, to our inpatient or outpatient representatives as soon as possible.
Many insurance companies now require pre-admission authorization certification, referrals and second surgical opinions. We recommend that you check with your insurance company before scheduling an elective admission. Failure to do so might result in a reduction of your insurance benefits. If your insurance carrier does not cover you at 100% , you will receive a bill for the portion due.
Your final hospital bill will include fees for patient care charges and personal items. Patient care charges include your room, daily meals, around-the-clock general nursing care and many behind the scenes services, such as pharmaceuticals and care-related supplies. These services are included in the DRG rate, which is the amount billed to your insurance company.
Personal items, which are not covered by your insurance, include private room differential and daily telephone service. Payment for these services is due upon discharge.
Not included in your hospital bill are fees for private duty nurses, or your attending physician's or any other specialists' fees. These providers will bill you independently of Good Samaritan Hospital.
You may also receive separate bills from physician specialists who interpret any test performed during your stay. Some examples are:
- Nuclear Medicine Specialist
- Emergency Room Physician Group
when Medicare is your primary insurance
If you are covered by Medicare insurance, you will need to complete a Medicare questionnaire. In many instances, you may believe that Medicare is your primary insurance, when in fact, it is not. If you have other insurance, it would benefit you to have this carrier billed first for your hospital services. Medicare will then become the secondary carrier.