UP Health System is committed to improving the health of our community. To continue in this mission, it is essential that payment be received for services provided.
As a courtesy to our patients and their families, we will submit your bill to your insurance company according to the listed guidelines. To do this efficiently, it is important that accurate and complete insurance information be presented at the time of registration.
The following are answers to frequently asked questions about billing and payment:
Q: What is a deductible?
A: A deductible is the annual amount a patient must pay for medical services (excluding premiums) before the insurance plan begins covering costs.
Q: What is a co-pay?
A: A co-pay, or co-payment, is the fixed dollar amount a patient must pay for each visit to a doctor’s office. The co-pay amount is set by the patient's insurance plan.
Q: What is co-insurance?
A: Co-insurance is a co-sharing agreement between the insured and the insurer under a health insurance policy that provides that the insured will cover a set percentage of the covered costs after the deductible has been paid. Similar to co-pay insurance plans except co-pays require the insured to pay a set dollar amount at the time the service is rendered.
Q: How do I find out the estimated charges for a procedure to be performed at UP Health System?
A: For cost estimates for the procedures we offer, please call our patient advocate at 906.449.1422
Q: Does UP Health System participate in my health plan?
A: If UP Health System participates with your health plan, the hospital has an agreement with your insurance company to provide services for its members. Please take a look at our list of participating insurance providers. Please check with your insurance carrier to verify that it will cover services at the hospital, physician practice and care providers you plan to visit.
Q: When am I responsible for obtaining approval from my health plan prior to receiving services?
A: Depending on your insurance plan, you may be required to contact your primary care physician or health plan for approval prior to receiving services. If your situation is truly an emergency (life-threatening), you or a family member must contact your physician or health plan within 24 hours of receiving treatment. If you do not obtain health plan approval, all hospital charges may become your responsibility. While insurance companies cover Emergency Room charges for true emergencies (life-threatening situations) and many outpatient services, coverage differs. Your insurance company may require you to pay for emergency and urgent care services determined to be non-emergency (non-life-threatening).
Q: What if the hospital doesn’t participate in my plan?
A: If UP Health System does not participate with your health plan, you may still receive services at UP Health System. However, you should know these services are considered out-of-network and may not be covered. You are responsible for paying the bill in full or for any balance not paid by your health plan. As a courtesy, we initially bill non-participating health plans. However, you are responsible for payment if the plan does not promptly respond to the claim.
Q: What insurance providers does UP Health System participate with?
A: Click here to see the full list of participating insurance providers.
Q: Will you bill my insurance company?
A: UP Health System will directly bill your insurance company and send you a statement after receiving the plan’s determination of the amount covered. Depending upon the services provided, if your insurance plan requires payment of a co-pay and/or deductible, you may be requested to pay this amount at the time of service. Immediate payment enables UP Health System to contain billing costs. If your insurance company has not responded to the claim within 45 days, you are responsible for assisting in obtaining payment from the insurance company.
Q: Why aren’t my doctor’s charges included on my hospital bill?
A: Most physicians, radiologists, pathologists, anesthesiologists and emergency room physicians are not employed by UP Health System. You (or your insurance company) may receive a separate bill for physician services. This separate physician billing practice is customary.
Q: Is there any way I can save money on my healthcare expenses? What if I am having trouble paying my bill?
A: UP Health System offers several ways for you to save on your medical expenses, including a prompt pay discount and a self-pay discount. We can help you set up a reasonable payment plan if you can't pay your bill all at once and we also offer a Financial Assistance Program to assist individuals who are uninsured for medically necessary healthcare services.
Q: What are Medicare and CHAMPVA patient rights?
A: UP Health System is required by the United States government to provide Medicare and CHAMPVA patients with specific information regarding their patient rights. If you have not received this information during your current hospital stay, please ask to speak to your unit’s Care Manager or call (269) 226-8311.
Q: How do I make a payment?
A: Patients may pay by check, money order, cash or credit card. If you cannot pay your bill in full at the time of service or at the receipt of your first bill, patient financial counselors are available to assist with billing questions and provide information regarding other possible payment options from 7:30 a.m. to 5 p.m., Monday – Friday. For more information, please call 906.449.1422
Q: My explanation of benefits (EOB) says I am not responsible for the usual and customary or reasonable and customary fees. What does this mean?
A: While your insurance provider may state that you are not responsible for these charges, UP Health System does not recognize reasonable and customary or usual and customary fees as a discount. Many charges may vary from one payor to another. Some charges are higher and some are lower. None of these factors justify charge reduction. Therefore, you are responsible for these charges.
Q: Why am I now getting a bill for services I received quite some time ago?
A: We regret the delay and any inconvenience the delay has caused. UP Health System must first work with various insurances to process claims and receive their payments before billing patients for the remainder of the balance.
Q: Why am I receiving a bill for the total amount of my visit? Haven’t you billed my insurance company?
A: UP Health System submits bills to insurance companies according to the listed guidelines. After receiving the plan’s determination of the amount to be covered, we send statements to patients. Depending upon the services provided or if the insurance plan requires payment of a co-pay and/or deductible, patients may be requested to pay this amount at the time of service. Immediate payment enables us to contain billing costs. If your insurance company has not responded to the claim within 45 days, you are responsible for assisting in obtaining payment from the insurance company.
Q: How can I request a total itemization of my account with UP Health System?
A: You can request an itemization of your account by calling 906.449.1422. When talking with a representative, you will need to verify your name, account number, address and daytime telephone number. Your itemized statement will then be printed and mailed to you within 48 hours.
Q: Why am I receiving statements for an account I paid?
A: Your statement may have been sent just prior to your payment, or we may have not processed your payment before your statement was sent. If you have recently paid for the account listed on the billing statement, please disregard the statement.