Billing & Insurance
Your Hospital Bill
You may receive a bill for your hospital stay. If you have any questions about any portion of your hospital bill or need to make special arrangements for payment, a member of our Finance Department will be happy to assist you. Payment of bills may be made by mail, online, or in person. The Hospital Cashier’s Office, located inside the main entrance, is happy to help you. Hours are 8 a.m. to 4:30 p.m. Monday through Friday.
Billing for Professional Services
Please note both inpatients and outpatients who require X-rays will receive a separate bill from the radiologist who reads the X-rays. Hospital radiologists read all X-rays to ensure proper diagnosis and treatment for all patients. Also, all patients who require laboratory tests will receive a hospital bill for testing and lab services. The pathologist fees will be billed separately for professional services in examining and analyzing blood, cells, tissue, or other specimens, reporting the findings, and consulting with the attending physician when appropriate.
No Surprises Act
Effective Jan. 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (or “surprise billing”)?
When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs such as a copayment, coinsurance, and/or a deductible. You may have other costs or must pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care — like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
- Emergency services — If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be “balance billed” for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. Additionally, Illinois protects patients from balance billing for: (i) covered medical services at an in-network hospital or ambulatory surgical center provided by an out-of-network facility-based provider, if (a) the patient has agreed in writing to assign their benefits to the out-of-network provider, (b) an in-network facility-based provider is unavailable and (c) the patient did not willfully choose the out-of-network provider; and (ii) covered emergency services at an out-of-network facility or provided by an out of network provider. This protection does not prohibit the imposition of in-network cost-sharing amounts. This protection applies to all insurers providing accident and health insurance, including health maintenance organizations (HMOs).
- Certain services at an in-network hospital or ambulatory surgical center — When you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most these providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
Additionally, Illinois law also protects patients from surprise medical bills for patients that have made a good faith effort to utilize in-network providers, but it is determined the insurer does not have the appropriate in-network providers. In this case, the insurer must ensure the beneficiary will be provided the covered service at no greater cost than if the service had been provided by an in-network provider.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost like the copayments, coinsurance, and deductibles you would pay if the provider or facility was in-network. Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization)
- Cover emergency services by out-of-network providers
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit
If you believe you’ve been wrongly billed, you may contact:
- The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227).
- The Illinois Department of Insurance Office of Consumer Health Insurance at (877) 527-9431.
Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. By law, healthcare providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider and any other provider you choose for a Good Faith Estimate before you schedule an item or service.
If you receive a bill at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit the CMS or call 1-800-MEDICARE (1-800-633-4227).
Insurance Plans Accepted
Carlinville Area Hospital & Clinics accepts the following insurance plans:
- Aetna Better Health
- Aetna Better Health MMAI
- Anthem Select Advantage
- Blue Cross Blue Shield Acute
- Blue Cross Blue Shield Swing
- Blue Cross Community
- Blue Cross Community MMAI
- Care Improvement Plus
- Cigna Healthcare of Il.
- Coventry, CCN, First Health
- Coventry Medicare Advantage
- Essence Healthcare
- Great West
- Health Alliance
- Health Alliance Medicare Advantage
- Healthlink PPO
- Healthlink HMO
- HFN, PPO
- HFN, WMC
- Humana Gold Medicare
- Humana Gold Integrated Plus
- Meridian Complete
- Molina Dual Options
- Multi Health Plan/PHCS
- Next Level Health
- Physicians Health Association of Il (PHAI)
- Sterling Life
- Sterling Option One
- United Healthcare
- United Healthcare Medicare Complete