Financial Information & Patient Billing
Halifax Health provides treatment based on the best interests of the patient, regardless of compensation or the ability to pay. Nevertheless, it is important that each patient provide adequate financial information to determine his or her insurance status, ability to pay and to participate in payment to the extent possible.
Prior to, or at the time of your admission, you or your representative may be required to make a payment depending on your financial information and the type and verification of insurance coverage you have. If the services are considered non-covered by your insurance, you will be asked to sign a notice of non-coverage and will be asked for payment unless other arrangements have been made.
You will need to present your insurance ID cards, photo ID and other pertinent information that will assist us in filing your insurance claim for you. Normally, insurance plans do not provide full coverage of the hospital bill. Either prior to, or immediately after your admission, your insurance coverage will be verified.
Your hospitalization coverage is a contract between you and your insurance company, and while we will cooperate to the fullest in expediting your claim, you are ultimately responsible for your account.
If your financial information indicates that you cannot pay, then you will be asked to apply for assistance through the Halifax Managed Care Assistance Program and/or the Department of Children & Family Services.
Filing Claims and Our Process
As a courtesy to our patients, we will file a medical claim (bill) to any health insurance company for services rendered at our facilities. We can only do so when the patient or guarantor has provided complete and accurate insurance information to us when arrangements for your care are made, or at the time services are rendered, or immediately thereafter.
We must have your insurance information in a timely manner in order for the proper authorizations, pre-certifications, referrals required by your insurance company are obtained, and any other notification that the company requires in order to pay for your treatment, tests or hospital stay.
Failure to meet these obligations may result in the patient or guarantor being responsible for the services rendered as a result of the insurance company not remitting payment. Patient Billing and Financial Services (PBFS) will make a reasonable attempt to collect the debt incurred from the insurance carrier, if for any reason your insurance company denies your claim or neglects to pay the bill, you, as the patient or guarantor, will ultimately be responsible for the charges incurred.
With the exception of those payers Halifax Health has entered into a contractual relationship with, Halifax Health is not bound to accept the reimbursement that an insurance company may pay or allow for the services rendered as payment in full. For example, some insurance companies use a payment methodology known as “UCR” (Usual & Customary Reimbursement) or otherwise known as an “Allowable”. Both of these payment (reimbursement) methodologies are determined by your insurance company and are not a mutually or contractually agreed upon amount of reimbursement between Halifax Health and the insurance carrier. This means that any difference between our total charges and the “UCR” or “Allowable” amount is the responsibility of the patient or guarantor.
Please check your insurance contract to see if your insurance carrier or coverage reimburses by either of these payment methodologies to prevent any unforeseen or non-covered medical costs.
Although your bill is due and payable at the time of your discharge, it sometimes requires several days to record all charges and payments on your account.
At your request you will be mailed an itemized statement reflecting such charges and payments and any remaining balance due.
Remember that Halifax Health Medical Center is billing for hospital charges only. Professional fees from your physician, specialists, and for radiology and pathology services or other specialized professional services will be sent by those providers or designated billing representative.
Questions about such billings, and arrangements to pay them should be made directly with each provider.
Patient Business and Financial Services
One call does it all when it comes to patient registration and billing thanks to Halifax Health’s Patient Business & Financial Services (PBFS).
This centralized service makes it easy for prospective patients to register prior to coming to Halifax Health for services. In addition, customer service representatives are available to answer questions about bills and insurance coverage. Patient Business & Financial Services is also the area responsible for patients’ medical records and health information.
Private Room and Other Fees
The majority of insurance companies, including Medicare, do not ordinarily pay for a private room. You will be responsible for any differential if you have requested a private room, and any other room charges not covered by insurance or Medicare.
Payment may be made daily, in advance, or at the latest, at the time of discharge. In addition to private room charges not being a covered service, many insurance companies deny reimbursement that differs from what they term or classify as ‘usual and customary rates.
Halifax Health considers our rates to be usual and customary for this area/community, and any reimbursement withheld for those reasons will be balanced billable to the patient or the patient’s responsible party.
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