Understanding Your Insurance Coverage

What to do before you need care
We encourage you to become familiar with the terms and conditions of your health insurance coverage and to review any changes each year. Understanding your insurance coverage can help you avoid unnecessary bills.

If you are a member of a managed care plan
Your health insurance plan may have special requirements, such as a second surgical opinion, prior authorization or limitation 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 you are referred to a specialist by your primary care physician or provider, you may want to confirm that the specialist participates in your health care plan.

If you are 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 (amount owed by you) is due within 20 days.