THE BILLING PROCESS
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The Billing Process
The billing process starts when you provide your insurance and demographic information at the time of registration. Please make sure you have provided the Admitter with your most current insurance information. The District will supply this information to the other care groups involved in your care.
The charges applied to your account are coded based on the physician order and chart documentation.
As a courtesy, the District will submit claims directly to your insurance company. The District will work with you and your insurance company to resolve any issues that may arise. If you have more than one plan the District will also bill your secondary/tertiary insurance.
Once your insurance has processed a claim they will send you an Explanation of Benefits (EOB) informing you of our charges, their payment amount and the amount for which you are responsible. The District will also receive an EOB and/or payment from your insurance company.
Patient Statements - If you are uninsured or have a patient balance after an insurance payment or denial you will received a statement from our billing agency (HRG). This is not a collection agency.
Your accounts will be considered resolved once we have received full payment. If you are uninsured, underinsured or having financial difficulty, please contact us at 209-966-3631, ext. 5120 to discuss payment plans or financial assistance that may be available.
DEPENDING ON THE SERVICE YOU RECEIVE, YOU MAY RECEIVE MORE THAN ONE BILL.
Emergency Physician, Hospitalists, Radiologist, and other Billing
If your insurance recognizes the District as a preferred provider but does not recognize the Emergency Physicians, the Hospitalists, or the Radiologists as a preferred provider please contact our business office at 209-966-3631, ext. 5120 so that we may address the situation.
The Emergency Department Physicians are private doctors who provide direct treatment, diagnostic services, and/or supervision of care for patients they encounter in the Emergency Department. The bill you receive from the Emergency Physicians (Yosemite Valley Medical Services) will only pertain to these professional services.
The bill from the Hospital will only pertain to charges incurred for the use of the Emergency Department treatment area, nursing, technical, and ancillary personnel, supplies, and equipment used in your care. It will not include the Emergency Physicians' fee.
Should you have a question about the Emergency Physicians bill please contact Yosemite Valley Medical directly at 800-355-2470.
Hospital In-patient (Acute) or Observation
The Acute Department Physicians, referred to as Hospitalists, are private doctors who provide direct treatment, diagnostic services, and/or supervision of care for in-patients and observation patients admitted for care. The Hospitalists' bill will only pertain to these professional services.
The bill from the Hospital will only pertain to charges incurred for the use of the Acute Department room/bed, nursing, technical, and ancillary personnel, supplies and equipment used in your care. It will not include the Hospitalists' fee.
Should you have a question about the Hospitalist bill please contact Rural Physicians Group directly at 702-933-3266, ask for Jackie Decker.
If you receive an x-ray, mammogram, CT scan, MRI, or ultrasound procedure/s, the films are reviewed and a report of the findings is prepared by a Radiologist. You will receive a separate bill from the Radiologist group, Central California Radiology, for their service.
The bill from the Hospital will only pertain to charges incurred for the use of the Imaging equipment, technical personnel, and supplies used in the procedure. It will not include the Radiologists' fee.
Should you have a question about your Central California Radiology bill, please contact them direct at 866-509-8452.
The District's laboratory is able to perform the majority of lab tests needed by our patients. However, there are some that we cannot perform at the Hospital and they would be sent out to Quest Laboratory for processing. For those labs sent to Quest for processing you will receive a bill from Quest.
Some lab tests, and various biopsies require evaluation by a Pathologist. If your care requires evaluation by a Pathologist the service will be billed by Merced Pathologist.
Should you have a question you about your Quest Laboratory or Merced Pathologist bill, please contact them direct at the number on their statement.
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