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Understanding Your Insurance Coverage

Get the Most from Your Coverage

We encourage you to get acquainted with the terms and conditions of your health insurance coverage before you need care. It’s a good idea to stay up to date by reviewing any changes in your insurance plan each year. Understanding your coverage can help you avoid unnecessary bills.

If You’re a Member of a Managed Care Plan

Your health insurance plan may have special requirements, such as a second surgical opinion, prior authorization, or limitations on where care is provided. If your insurance plan’s requirements are not followed, you may be financially responsible for all or part of the bill for services provided by the hospital or clinic. If your primary care physician or provider refers you to a specialist, you may want to confirm that the specialist participates in your health care plan.

If You’re Covered by Medicare and a Secondary Insurance

Medicare will be billed first. Once Medicare’s payment is received, your secondary insurance will be billed. Please be advised that Medicare does not cover some items and services, including dental-related services, self-administered medications (such as pills), personal comfort items, hearing evaluations and others. After Medicare and any secondary insurance have paid their portions, you will be billed for any deductibles, copayments and non-covered items that are your responsibility.

Billing Your Insurance Company

Providence will submit bills to your insurance company when complete information is supplied. Please remember that your policy is a contract between you and your insurance company, and you have the final responsibility for payment of your bill. If your insurance company does not pay within 30 days of billing, please contact them to resolve the delay. Secondary insurance is billed after the primary (or first) insurance pays. After your insurance company processes the bill (also known as a claim), the balance (the amount owed by you) is due within 20 days.