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Thank you for choosing the Hiawatha Community Hospital for your medical needs. Every person receiving care is given the same rights and is treated with the same high level of respect and dignity regardless of ability to pay.
It is necessary for the Hospital to have a copy of your insurance card to meet the special requirements of your company. Failure to provide accurate and current insurance information may result in penalties or a reduction of benefits by your insurance company. It is your responsibility to know the limitations and coverage requirements of your insurance company. Insurance companies do not pay requested private room charge ($10.00 a day).
Discharge planning often begins at the time of admission. The case manager will contact your insurance company to assess your needs and to plan your care. The Hospital will file your insurance claim directly to your company and will do everything possible to expedite your claim. The Hospital cannot guarantee payment of insurance claims and all payments are the direct responsibility of the patient (guarantor). You will be billed for the balances considered patient responsibility as contracted with your insurance.
You are responsible for meeting any requirements stipulated by the contract with your insurance company. This includes all requirements for pre-authorizations, referrals, pre-determinations, and completion of any questionnaire for your insurance company. Referral and authorization forms must be sent to your insurance company by your physician. In most cases, the hospital is not allowed to provide referrals. The hospital is not always aware of your policy limitations. It is the responsibility of the patient to dispute the claim with the insurance company if any portion is denied.
MOTOR VEHICLE ACCIDENT
Kansas is a no-fault state. Kansas law requires that all injuries resulting of ownership, operation, maintenance or use of a motor vehicle must be filed to auto insurance. This applies even if you are a passenger in the vehicle. You must provide the Hospital with the name of your automobile insurance carrier. Failure to comply will make the bill your responsibility. Health insurance will not pay for services related to an auto injury. It is also the patient’s responsibility to complete all forms required by your auto insurance for payment of the claim.
The Hospital must be informed at the time of admission if treatment is due to injuries that occurred on the job, on company time, or as the result of occupational circumstances. You are required to provide the name and address of your employer and to report the accident to your employer. Failure to do so may result in the loss of benefits. Health insurance generally will not pay claims determined to be work related.
All uninsured patients, upon request, will be extended a 10% discount on charges if payment in full is received within thirty (30) days of the first billing date.
Itemization of charges is available upon request by calling 785-742-6250. Payment in full within 30 days of the first billing is expected. If payment in full is not possible, the Hospital does offer the following payment options. Please notify the Office Manager of which option you have chosen. 1) on balances of $500.00 or less equal installments to be paid out within 6 months; $501.00-$1500.00 equal installments to be paid out within 12 months; $1501.00 or above, equal installments to be paid out within 18 months.
2) If a patient cannot make payments following the above payment guidelines, a Financial Data Sheet must be completed, signed, and verified with proof of current income to qualify for a reduced payment level according to the Hospital’s Charity Care Policy. The opportunity for a bank loan is also available which may reduce your monthly payment obligation. The loan applications are available upon request from the Business Office Manager.
It is the policy of the Hiawatha Community Hospital to accept and treat all patients regardless of their ability to pay. Charges are made to patients for all services rendered. The Hiawatha Hospital recognizes that not all patients have the financial resources to pay their hospital bill according to the Hospital’s payment policy.
If the patient has Medicare, Medicaid or other insurance the hospital will bill these before any charity is applied. It is the patients’ responsibility to help the hospital in its efforts to collect from third party payers. If a patient refuses to cooperate with the hospital, no consideration will be granted. Non emergent and/or elective procedures (i.e. obstetric services, elective surgeries, screening tests, etc.) are not eligible for Charity Care consideration. In the case of recurrent obligations that are non emergent or the patient is uninsured, the hospital may request that the patient first seek public benefits. Upon verification of denial for public assistance, the hospital will extend consideration.
Charity Care will be considered only for patients whose primary care physician is an active medical staff member of the Hiawatha Community Hospital.
Charity Care will be considered for indigent patients who are experiencing financial hardship and/or have incurred excessive medical expenses and clearly lack the ability to liquidate their indebtedness; or may be struggling with their financial responsibilities. To accommodate these patients, the following guidelines apply.
- Patients who seek financial assistance should apply to the Business Office Manager in the patient accounting department. The patient or guarantor must complete with current data, sign, and return the Hospital’s Financial Data Sheet with supporting documentation as requested within 10 (ten) days to the Business Office Manager
- The Hospital guidelines are based on poverty income level as established by the Department of Health and Human Services (revised annually). Income is defined as household total annual cash receipts from all sources before taxes.
- The hospital may deny assistance if the patient or guarantor has assets such as saving accounts or investments, or available funds or does not furnish all requested information.
This consideration process is by application only and the applications are available upon request by calling 785-742-6250 or by completing the Charity Care Application.
2009 Poverty Guidelines and Reduced Rates
||100% Discount if income is equal to or below
||40% Discount if income is equal to or below
||15% Discount if income is equal to or below
For questions about a hospital bill please contact:
Jeanette Kocher, Business Office Manager
Telephone: 785-742-6250 Fax: 785-742-6558
For questions about a clinic bill please contact:
Jennifer Ploeger, Clinic Manager
Telephone: 785-742-6402 Fax: 785-742-6554