Billing and Financial Assistance

This is an estimate and the actual total cost (patient responsibility) may be different than the amount shown in the following estimate. The cost estimate does not include any physician or other professional fees. The use of any information provided by Sioux Center Health’s Patient Cost Estimate tool is confidential and intended for the well-being and medical care of patients. Any attempt to use the Patient Cost Estimator for any purposes other than those intended by Sioux Center Health and determined by Sioux Center Health in its sole discretion is prohibited.

All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the hospital’s billing procedures and charges. If there is a question about your insurance coverage, please call us at 712-722-8297 or a member of the Business Office will contact you or a member of your family while you are here. Information is needed in order to process your claims.

If You Have Health Insurance

We will need a current copy of your identification card.

If You Are a Member of an HMO or PPO

Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered.

If You Are Covered by Medicare/Medicaid

We will need a copy of your Medicare card to verify eligibility and process your Medicare claim. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations, and others. Deductibles and co-payments also are the responsibility of the patient.  We will need a copy of your Medicaid card. Medicaid also has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary.

If You Have No Insurance

A representative from the Business Office will discuss financial arrangements with you. Financial assistance, payment plans, and lump-sum payment discounts are all available through the Business Office.

Your Hospital Bill

The hospital submits bills to your insurance company as a courtesy and will do everything possible to expedite your claim. But you should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill.

Your bill reflects all of the services you receive during your stay. Charges fall into two categories: a basic daily rate, which includes your room, meals, nursing care, housekeeping, telephone, and television; and charges for special services which include items your physician orders for you, such as X-rays or laboratory tests.  If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists, and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.

Sioux Center Health’s mission is to care for all patients regardless of ability to pay. No one should put off needed medical care because of a lack of health insurance or concern about paying. Sioux Center Health will treat you with dignity and respect, regardless of your ability to pay.

Let us know if you think you may have problems paying your part of your bill. Business office or billing staff can discuss payment options that may be available to you:

• Extended payments
• Government programs
• Charity care/patient assistance considerations
• Count on Sioux Center Health billing staff to help you understand your situation, and help you in applying for aid, when needed

For those who do not qualify for government programs, Sioux Center Health’s Charity Care and Patient Assistance Programs allow you to get care at no obligation or discounted obligation, based on your income and family size. These programs are available once all other third-party resources (including local assistance programs) are exhausted.

To help determine if you qualify for Sioux Center Health’s Charity Care and Patient Assistance Programs, Sioux Center Health:

• Uses income guidelines issued by the U.S. Department of Health and Human Services
• Considers all of your financial assets and liabilities
• Requires you to provide the personal and financial information we ask for, including W-2 forms, bank statements, tax returns and pay stubs

You will continue to receive a bill until we decide if you qualify for the program.

Background

In an era of increasing health care costs and consumer-driven financing alternatives, the need for pricing transparency in health care services has taken on increasing importance. Sioux Center Health (SCH) is committed to sharing information in ways that will help make informed decisions about health care services. However, issues surrounding hospital pricing remain complex and include many factors. SCH prices vary based on patient needs and the level of services consumed. A wide range of products and services are bundled into the price of particular hospital services, including medications, supplies, tests, and more. Hospital “reimbursement” varies from patient to patient based on the payments mandated by different insurance companies, health plans, and government payers such as Medicare and Medicaid. All of these factors combine to make specific advance pricing information difficult to provide on an individual basis.

SCH is at the forefront of providing meaningful consumer information, with the continuous goal of providing efficient and effective outcomes for all patients. SCH supports the goal of pricing transparency for health care services.

The Goal of Pricing Transparency

The goal of pricing transparency is to provide useful information about SCH and other health care facilities on a comparative basis across the various services provided.

SCH Position

SCH is committed to public information and accountability. SCH charge information can be found via the Iowa Hospital Association (IHA) website (www.ihaonline.org). This will allow either basic or more advanced searches of charges associated with hospital inpatient and outpatient services, as well as provide the opportunity to compare hospitals to one another.

In addition, the website will also allow access to various other information, including hospital quality indicators (via the Iowa Healthcare Collaborative), community benefit services, economic impact data, and the IHA principles on billing and collection policies which every Iowa hospital board has endorsed.

While this is a significant first step in the arena of health care pricing transparency, consumers should recognize that charge data is not indicative of the price that a consumer will actually pay for services. Consumers should contact their insurer or individual hospitals regarding the specifics of their health care coverage options.

Sioux Center Health recommends that the following additional information be taken into consideration: