Price Transparency

 

Patients are encouraged to find out as much information about the cost of their health care before they arrive at Graham Regional Medical Center.  The cost of your care is dependent on your health insurance coverage and provider.  Speaking with your insurance company or Medicare/Medicaid can help you better understand your plan, deductible, and coinsurance amounts.

Graham Regional Medical Center complies with the Centers for Medicare and Medicaid Services which requires all hospitals to post their standard charges online. Please visit our Price Transparency Tool to help make an informed decision regarding your care.

These charges do not include physician or other provider’s fees that may be billed separately from the hospital's fees. You may receive bills from multiple physicians for their services, including but not limited to your anesthesiologists, hospitalist, pathologist, radiologist, emergency room physicians, and other specialists who participate in your care. If you have questions about your bill for their services, please contact the individual provider.

 

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and/or deductible. 

Graham Regional Medical Center accepts most forms of health insurance. Our staff processes patients’ insurance submissions as a free service.

GRMC is in-network & accepting the following insurance programs:

BlueCross BlueShield

Aetna

Cigna

Humana

UnitedHealthcare

TRICARE Standard

Medicare

Medicaid

Medicare Advantage plans accepted

Other Commercial insurance accepted

It’s always a good idea for individuals to read and understand their health insurance benefits. Making sure the hospital and physician providers are covered under the health insurance plan is important. We can help you navigate your way through the billing and insurance process. Just give us a call at (940) 549-3400.

 

Billing Dictionary- Common Insurance Terms Explained

Co-insurance

The percentage of your healthcare bill is your responsibility. Normally, insurance plans have at least a co-payment or a co-insurance.

Co-payment

The pre-set dollar amount you have to pay before insurance coverage begins. As part of your policy, co-payments are paid for the medical service received.

Deductible

Amount an insured patient family has to pay before the insurance company pays benefits. Typically, the deductible is calculated as an annual expense per person and per family. If your insurance plan has a deductible. Sometimes referred to as your first “dollar expense” must pay out of pocket the approved insured amounts until your out-of-pocket expense has hit this threshold.

In-network/out-of-network

Whether the doctors or facilities are participating or not participating with your insurance plan. Physicians negotiate their own insurance contracts. Some physicians could be out-of-network for your insurance even though GRMC is in-network.

Explanation of benefits (EOB)

Itemized charges and distribution of payments. An EOB is sent from the insurance company to both GRMC and the patient/family post service explaining how your benefits were applied to your claim

 

Coordination of benefits (COB)

Some families have two (or more) health insurance plans. The COB tells insurance companies how to split the cost of your health care. It’s important that you fill out a COB form from each insurer – even if you have only one insurance plan. This way, your insurer will know how much to pay for your child’s health care. Contact the member services number or website found on your insurance card(s) for more information.

How is the portion I am going to pay determined?

• The portion you pay is determined by the patient’s insurance plan. That is verified at the time of service with your insurance company.

  • Co-payments in Admitting, ER, and Day Surgery are expected to be paid at the time of service unless other arrangements have been made prior to service provided

• Patient family signs release of information (at time of arrival)

• GRMC bills directly to the patient’s insurance company

• Insurance company processes the claim and sends GRMC and the family an Explanation of Benefits (EOB)

• GRMC creates a bill showing portions paid and sends it to the family

 

Who is responsible for paying the bill?

Patients without insurance are expected to pay their accounts at the time of service.  Patients without insurance are eligible for a self-pay discount.

Patients with HMO, PPO, and other commercial insurance are responsible for all co-payments, deductibles, and co-insurance at the time of services unless prior arrangements are made with our financial counselor.

Patients with Medicare who do not have supplemental or secondary insurance may also be responsible for co-payments, deductibles, and co-insurance at the time of service.

How long do I have to pay my bill?

Once your insurance company has processed their payment to GRMC, the remaining balance is immediately due. You have 90 days from the time it becomes the patient responsibility to pay the bill in full. If the bill is not paid in those 90days or a payment arrangement is not made the account will be turned into bad debt.

 

It’s always a good idea for individuals to read and understand their health insurance benefits. Making sure the hospital and physician providers are covered under the health insurance plan is important. We can help you navigate your way through the billing and insurance process. Just give us a call at (940) 549-3400.