Financial Services

Helping You Understand the Cost of Care at Melissa Memorial Hospital

We know that medical billing and insurance can be confusing. At Melissa Memorial Hospital (MMH), we are committed to price transparency and to helping you understand the costs of your care and the resources available to assist you.

How Are Charges (Prices) Established?

Charges for medical services at MMH are determined based on several important factors:

• The cost of staff, equipment, medications, and supplies used in patient care
• The amount of time our facilities and staff are involved in your care
• Administrative expenses, including billing systems, housekeeping, and technology
• Insurance company contract terms and negotiated rates
• Guidance from the Centers for Medicare and Medicaid Services (CMS)

What is the No Surprises Act?

The No Surprises Act protects patients from unexpected medical bills from out-of-network providers in emergency or certain non-emergency situations. It ensures greater price transparency and requires providers to offer a good faith estimate of charges in advance of care.

Learn more in this Detailed Summary of the No Surprises Act from the American Hospital Association (AHA).

Understanding Medical Billing Codes

CPT Code

CPT stands for Current Procedural Terminology. A CPT code is a five-digit identifier used across the healthcare system to describe procedures and services. You’ll find CPT codes on our pricing lists to help match specific procedures with associated costs.

DRG Code

DRG stands for Diagnosis-Related Group. DRGs are used for inpatient hospital stays to classify types of care and calculate costs based on diagnosis, procedure, and length of stay. DRG codes help insurers determine reimbursement rates.

What If My Procedure Isn’t Listed?

We list prices for many standard procedures on our website. If your service is not listed, please reach out:

Will My Bill Be Different Than the Price Listed?

Possibly. The price you ultimately pay can be influenced by:

• Additional testing or services during your visit
• Your specific diagnosis and treatment plan
• Your insurance plan’s coverage and network status
• Physician decisions made at the time of care

Insurance & Network Participation

Does MMH Accept My Insurance?

To see if MMH is in-network with your plan, or call your insurer directly. MMH will file claims to any insurer you authorize, but you are responsible for any portion not covered by your plan.

Is MMH Out-of-Network?

You can still receive care at MMH, especially in emergencies. For non-emergencies, please check with your insurance provider about out-of-network coverage and potential higher out-of-pocket costs.

What About Physicians?

Even at an in-network hospital, some specialists (e.g., anesthesiologists, radiologists) may be out-of-network. Check with your insurer to confirm physician network participation or request in-network billing agreements when possible.

Understanding Your Estimate & Final Bill

How Will I Know What I Owe?

We will provide an estimate based on the expected services and your insurance benefits. This is not a guarantee but a helpful starting point. Why Might My Estimate Differ from My Final Bill?
Medical needs can change during your visit, resulting in different services than originally estimated. After your visit, your insurance company will send you an Explanation of Benefits (EOB) outlining coverage. Compare it to your MMH bill and contact us or your insurer with questions.

Financial Assistance

Need Help Paying Your Bill?

We are here to help—whether you have insurance or not.

If You Have Insurance

Our Financial Assistance Specialists can help identify additional programs to bridge the gap, including Medicaid, Social Security benefits, or hospital-based financial assistance.

If You Don’t Have Insurance

Call us to explore eligibility for:

• Medicaid or Medicare
• Health Insurance Marketplace plans
• MMH’s Community Financial Aid Program

Discounts are available based on household income and family size. Emergency care will never be delayed or denied based on your ability to pay.

Commitment to Quality Care

Melissa Memorial Hospital is proud to exceed national benchmarks in preventing hospital-acquired infections and ensuring patient safety. Our dedicated staff prioritizes quality care and transparency at every step.

Payment 

Illnesses and injuries always seem to come at the most inconvenient times. Our team is here to guide you and help you find the resources you need when it matters most.

Financial Assistance 

If you’re facing challenges in paying your hospital bill, you may be eligible for financial assistance. We are committed to providing support to ensure that you can access the care you need.

Starting September 1, 2022, patients have the following rights:

• Eligibility Check: Determine if you qualify for discounted care or public health care coverage.
• Payment Plans: If eligible, you can be offered a flexible payment plan to manage your expenses more easily.

To apply for financial assistance, please fill out the application provided below. For additional information regarding your rights as a patient and our financial assistance programs, you can download the informational form.

At Melissa Memorial Hospital, we strive to maintain transparency in our pricing, enabling you to make informed decisions about your healthcare costs. We offer various resources to help you understand the expenses associated with your medical care, empowering you to plan for future healthcare needs.

For more details, please explore the following links:

Insurance Information for Patients at Our Rural Hospital

At our rural hospital, we understand the importance of accessible healthcare, and we strive to accept a variety of insurance plans to best serve our community. Below is some important information regarding the types of insurance we accept and how you can verify your coverage.

Common Insurance Types Accepted

Commercial Insurance:

We accept numerous commercial insurance plans, including but not limited to:

• Blue Cross Blue Shield
• Aetna
• Cigna
• UnitedHealthcare
• Humana

Additionally, other major carriers such as Anthem, Health Net, and Oscar may also be accepted. It’s essential to check with our billing department regarding specific plan variations, as acceptance can vary slightly.

Government-Sponsored Programs:

We accept a range of government-sponsored programs, including:

– Medicare: Available for eligible individuals, covering a variety of healthcare services.

– Medicaid: Offered to eligible low-income individuals and families.

– CHIP (Children’s Health Insurance Program): Coverage available for children in qualifying families.

Understanding Plan Types

Health Maintenance Organizations (HMOs):

HMOs typically require you to choose a primary care physician (PCP) and get referrals for specialist visits.

Preferred Provider Organizations (PPOs):

PPO plans offer more flexibility in choosing healthcare providers without needing a referral, although out-of-network care may incur higher costs.

Point of Service (POS) Plans:

POS plans combine features of HMOs and PPOs, requiring a PCP and referrals while allowing for out-of-network healthcare at an increased cost.

Behavioral Health Coverage

We work with specific behavioral health providers and networks to accommodate mental health needs, so please inquire if you have questions regarding this coverage.

How to Check if Your Insurance is Accepted

1. Visit Our Website:
   • Our website features a dedicated section on billing and insurance that lists accepted plans.
2. Contact Our Billing Department:
   • You can reach out directly to our billing department for any specific inquiries regarding your insurance plan’s coverage at 970-854-2241.
3. Check Your Insurance Company’s Website:
   • Many insurance companies provide a directory of participating hospitals to help you verify our facility as an in-network provider.
4. Call Your Insurance Company:
   • For further confirmation, consider calling your insurance provider to ensure coverage at our hospital.
5. Be Mindful of Limited Benefit Plans:
   • Some plans may offer limited coverage; understanding your plan’s details can help you avoid unexpected out-of-pocket costs.

We are committed to providing quality healthcare to our rural community and want to ensure that financial concerns do not hinder access to necessary services. If you have any further questions regarding insurance coverage or billing, please don’t hesitate to contact our team at 970-854-2241.