Frequently Asked Questions
About Billing and Insurance
Do you offer payment arrangements?
Yes, payment arrangements may be made by
contacting the Patient Service Center Monday through Friday 9 a.m. to 4 p.m., by calling 215-481-5777. We also accept most major credit cards.
Why do I receive separate bills from the hospital and from the physician?
When a physician specialist (cardiologist, pathologist, radiologist, etc.) performs these services, he/she is required by law to submit their bill separate from the hospital's bill.
Will you bill my primary and secondary insurance carriers?
Yes, as a courtesy to our patients, Abington Memorial Hospital will submit the bill to your insurance carrier and will assist when problems arise. You are requested to supply the pertinent billing information that the insurer may require. For example, a referral for the specific date of service.
Is there any help available that allows me to better understand my billing statement?
Yes, our interactive tool, Understanding Your Bill, which helps to explain the various sections of your bill. You may also wish to contact the Patient Service Center at 215-481-5777, or you may e-mail us: firstname.lastname@example.org
Are itemized statements automatically sent to patients?
Yes, the first statement that you receive is itemized. If for any reason a copy is needed thereafter, you can contact the Patient Service Center of Abington Memorial Hospital at 215-481-5777 and request an itemized and/or detailed billing invoice.
Is there any help available if I am experiencing a financial or medical hardship?
Yes, eligibility for financial assistance is determined by the patient's and/or guarantor's ability to pay, after all insurance and available resources have been utilized. The program covers payment for medically necessary care, but does not cover routine co-pays and deductibles for patients having medical coverage unless a hardship can be documented. The program also excludes services deemed not medically necessary, such as cosmetic surgery or fertility services. Applicants must be prepared to apply for other social programs that are available as well. Applicants must have the necessary verification and information needed to process the application.
Why is a service billed as an outpatient service when I spent the night in the hospital?
For an account to be billed as an inpatient service, there must be a physician order. The physician who ordered your services determined that your condition did not meet the requirements for an inpatient admission. The physician's written order dictates whether we bill as an inpatient or outpatient.
Why is a service billed as an inpatient service when I did not spend the night in the hospital?
For an account to be billed as an inpatient service, there must be a physician order for admission. There is no required length of time that a patient must be in the hospital to be considered an inpatient, nor must a patient spend the night. The inpatient determination is driven by the physician order to admit and his/her expertise that the level of care necessitated an inpatient status. The physician who ordered your services determined that your condition warranted inpatient care. The physician's written order dictates whether we bill as an inpatient or outpatient.
Why did my insurance carrier deny the claim?
Your insurance carrier may deny the claim for one or more reasons. It is always best to call member services at your insurance carrier to discuss your account. Some popular reasons are:
- You were not covered by your plan on the date of service.
- The patient cannot be identified.
- The primary physician did not issue a referral.
- The service was not authorized.
- The service that you received was out of network.
- The balance is due to the patient's deductible and/or co-pay.
- The account denied as "other insurance carrier is primary."
What is a deductible?
Deductibles are provisions that require the member to accumulate a specific amount of medical bills before any benefits are paid. Once the patient/insured has met their deductible, the insurance carrier usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are usually annual, and generally start in January.
What is co-insurance or co-pay?
Co-insurance and/or co-pay is a form of cost sharing. After deductibles are met, the plan will begin paying a percentage of the insured's bill. The remaining amount, known as the co-insurance, is the portion due by the patient and/or insured. Managed care carriers charge co-pays for varied services. For example, Emergency room visits, specialist, physical therapy and mental health services.
Why did the insurance carrier only pay part of my bill?
Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services and co-pays for some services such as those rendered within the emergency room and for specialist visits.
Why do I need to call the insurance carrier if they do not pay the bill?
You are ultimately responsible for the total bill or any portion of the bill that your insurance carrier did not pay. The Patient Service Center of Abington Memorial Hospital will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance.
I belong to a managed care plan. What should I do before coming to Abington Memorial Hospital?
The best patient is an informed patient. Read your insurance booklet to be sure you have followed all the guidelines for referral and authorizations, or call member services at your insurance carrier for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process. If you receive a verbal authorization number, please provide us with this information at registration.
I belong to a managed care plan but needed to be seen in the emergency room, what should I do now?
If you did not contact your primary care physician or your insurance plan before you came to the emergency room after receiving services, you may need to contact them within 24 hours to explain the reason of your visit.
What does "In-network" and "out-of-network" mean?
If you receive your healthcare services from a hospital, physician or other health provider that participates in your health plan, they are considered "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network." You may have a higher co-insurance and/or co-pay for out-of-network services. In some cases, out-of-network services are denied totally.
How do I know if my health plan requires a referral or pre-certification for a service?
Your benefit booklet or provider directory should provide this information for you. If not available, call your member service unit at the insurance carrier and they should be able to help you.
What should I do when I relocate or change my address and/or telephone number?
When your personal information changes you should always notify the hospital and/or medical providers of the change by contacting the Patient Service Center at 215-481-5777.
What should I do when my insurance carrier has changed?
When you experience any changes regarding your health insurance you should contact all the providers that offered medical services to you.
What should I do if my health plan includes Abington Memorial Hospital as a participating provider, but I receive an explanation of benefits stating I am out of network?
Consult your health plan's member services unit.
What should I do when my visit to the emergency room is a result of an automobile accident?
When you are involved in an automobile accident, contact the adjuster at your automobile insurance carrier immediately. The adjuster will give you a claim number specific to the accident and request that you complete and return a questionnaire that describes how and when the accident occurred. The questionnaire, known as the PIP form, must be returned promptly and notably, before any benefits will be paid out. Telephone the Patient Service Center of Abington Memorial Hospital to offer the appropriate insurance information for billing so that you are not liable for the bill. Also, be sure to provide any medical insurance information including a referral or authorization, if this is a requirement of your health insurance carrier. This will enable us to bill your health insurance carrier for any remaining balances due after your auto insurance carrier has paid their portion.
Auto-related injuries (pdf)
Bus, Train and Trolley accidents (pdf)
What should I do when my visit to the emergency room is a result of an injury incurred on the job?
When you are injured on the job, notify your supervisor and complete the employer's appropriate forms for workers compensation. Make sure you seek services from the panel of providers if this is a requirement of your employer. Telephone the Patient Service Center with the name of the employer's workers compensation insurance carrier and the appropriate insurance information for billing. Also, be sure to provide any medical insurance information so that we can bill your medical carrier if the service is denied by the workers compensation carrier.
What should I do if I received a medical service at Abington Memorial Hospital during a period when I did not have healthcare insurance?
If you received medical services during a time when you did not have health insurance, contact the Patient Service Center of Abington Memorial Hospital at 215-481-5777 immediately. A service representative will inform you of the varied options available.
Can I receive a Medical Assistance application from the Patient Service Center?
Yes, a supply of medical assistance applications are available. The hospital also has a relationship with a third party company that can help you walk through the application process for inpatient coverage and selected outpatient services. Contact the Patient Service Center of Abington Memorial Hospital at 215-481-5777 Monday through Friday from 9 a.m. to 4 p.m.
When is Medicare always primary and how do you determine if Medicare is primary or secondary?
Medicare has specific guidelines to help us determine if they are the primary payer or the secondary payer. Some of the more common situations where Medicare can pay as secondary are: (1) when the individual or his/her spouse is currently employed/working and covered under an employer group health plan as a result of current employment. (2) The company has 20 or more employees or participates in a multiple-employer or multi-employer group health plan where at least one employer has 20 or more employees. (3) The individual in question is entitled to Medicare as a result of a disability, the company has 100 or more employees, or participates in a multi-employer/multiple employer group health plan where one employer has 100 or more employees. (4) The individual in question is Medicare entitled due to end stage renal disease. Medicare is the secondary payer to a group health plan until a 30-month coordination period has ended.
What insurance carriers have contracts with Abington Memorial Hospital?
- Aetna (HMO/PPO)
- CCN PPO
- Humana ChoiceCare Network
- Cigna (HMO/PPO)
- Clear Care (WALMart)
- Devon Health
- EverCare (United Medicare Product)
- Health Partners
- Independence Blue Cross
- Interplan PPO (DirectCare America)
- Keystone/ Personal Choice
- Keystone Mercy Health Plan
- Preferred Care PPO
- Preferred Health Network (previously - Maxnet)
- One Health Plan/Great West
- Private Healthcare (PHCS)
- TriCare Prime
- United HealthCare
- United Payors PPO
- USA HealthNetwork
- Valley Preferred
What is the telephone number to Associated Professional Providers?
The Radiology Group of Abington - 800-543-2914
The Emergency Physicians Group - 800-456-4629
The Anesthesiology Group of Abington - 888-554-4121