#Horizon bcbs direct access providers professional#
For example, a cardiologist, pathologist, radiologist or anesthesiologist will each send a separate bill for his or her professional services. You may receive a separate bill from your personal physician and any other physician(s) involved in interpreting tests or performing other services. The hospital bill does not include fees of any treating physicians. You are responsible for any charges not covered or approved by your medical insurance company or managed care organization. Usually, one bill is sent for the use of hospital equipment, supplies, your room and board, and the time the nurses and other staff spent meeting your health care needs. You will probably receive more than one bill for services rendered by the hospital. If you have any questions, please contact your insurance company or speak to your Atlantic Health System care manager. If you were admitted to the hospital through the emergency department, be sure that your insurance company is immediately notified of your admission. Be certain to check this pre-certification requirement before your admission. Your insurance or managed care plan may require you to obtain pre-certification or pre-authorization for hospitalization, a procedure, surgery or service before they can be provided by the hospital and health care provider. Your prompt payment of any deductible, coinsurance and/or co-pay is also appreciated. You can also assist the hospital by promptly responding to Coordination of Benefits (COB) requests that you may receive from your insurance carrier.
Please assist the hospital in appealing to the insurance carrier for any services that are not paid.
Insurance carriers frequently deny claim submissions after 60 days, and payment for late submissions may be considered a patient responsibility. You should follow up with the insurance carrier or hospital if you have not received a bill or notice of payment within 45 days of service. You should verify the accuracy of any bill when you receive one, and compare statements from the hospital and insurance carrier to ensure that they are in agreement. If a claim is not paid within 75 days, the hospital will consider the bill a patient responsibility. Most insurance carriers take 30 to 45 days to process a claim, after which the hospital will seek your assistance in getting paid. Atlantic Health System facilities are considered network participants with many insurance companies, including those that are part of the Health Care Exchange (Affordable Care Act).
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