Before You Leave the Hospital
Expect a member of the AnMed financial team to review your benefits coverage and visit you before you go home if you have any financial responsibilities. Financial assistance programs are available to help.
What a Hospital Bill Covers
Your hospital bill covers the cost of your room, meals, 24-hour nursing care, laboratory work, tests, medication, therapy and the services of hospital employees. You will receive a separate bill from your physicians for their professional services.
For example, if you have an X-ray taken at AnMed, you’ll receive two bills. One is from the hospital for the use of equipment, supplies, medications and personnel. The other bill will be from the radiologist who interprets the X-ray.
Call the phone number on each separate statement if you have questions about your bills.
To receive your full policy benefits, most insurance plans require precertification for hospital stays and certain tests and procedures. It’s your responsibility to complete precertification using the information on your insurance card. If you’re unsure of your precertification requirements, contact your insurance company as soon as possible.
Coordination of Benefits
When you or a family member has two or more insurance policies, insurance companies refer to the payment process as coordination of benefits (COB).
COB can happen when spouses or partners are on each other’s insurance policies, when both parents insure their children on their individual policies, or when there is eligibility under two federal programs. Another example is when you or a loved one is involved in a motor vehicle accident and have medical and automobile insurance.
Most insurance companies have COB provisions determining the primary payer of medical expenses. This prevents duplicate payments. You must identify COB priority at admission to comply with insurance guidelines. Your insurance may request a completed COB form before paying a claim. We will try to notify you if this happens. AnMed cannot provide this information to your insurance company. You resolve the issue with your insurance carrier for the claim to be paid.
Medicare Status & Stay Information
Your hospital status—whether the hospital considers you an inpatient or outpatient—affects how much you pay for hospital services like X-rays, drugs and lab tests. “Inpatient” means you stay in the hospital overnight. “Outpatient” means you visit us for a procedure and return home the same day.
Medicare & Skilled Nursing Facilities
Your status can also affect whether traditional Medicare covers your care in a skilled nursing facility (SNF) because you must have a “qualifying hospital stay” first. Qualifying hospital stay means you’ve been a hospital inpatient for at least three days in a row (counting the day you were admitted as an inpatient, but not the day of your discharge.) Always ask your doctor or hospital staff if Medicare will cover your SNF stay.
Your doctor may order “observation services” to decide whether you need to be admitted to the hospital or go home. You're considered an outpatient when you’re getting observation services in the hospital. You cannot count this time toward the three-day inpatient hospital stay needed for Medicare to cover your time in a skilled nursing facility.
Medicare requires a review of inpatient admission, length of stay, and professional services to determine the medical necessity of the services you receive. Your doctor may determine your hospital stay to be inpatient at the start of your stay. Or your doctor may admit you as an outpatient observation patient, but then later determine that inpatient admission is necessary. In either scenario, your entire stay will be considered inpatient. You will be responsible for any Medicare Part A deductible, room difference and non-covered charges.
Exclusions from Medicare Coverage
Medicare does not cover all healthcare expenses. Some services excluded from coverage are dental, cosmetic and outpatient self-administered drugs.
More Medicare Coverage Details
Explore more detailed information on how Medicare covers hospital services, including premiums, deductibles and co-payments; visit www.medicare.gov/publications to view the “Medicare & You” handbook. You also can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-487-2048.
We will need a copy of your Medicaid card. Medicaid has payment limitations on several services and items. It does not pay for the cost of a private room unless medically necessary.
You must provide all health insurance-related information, such as policy number, group number and the correct mailing address for your insurance company during registration. AnMed will forward a claim to your commercial insurance carrier based on your information.