No Surprise Billing - Understanding Your Bill
Know your Rights — Don't be Surprised
We at NWH know that understanding your health benefits and what is covered can be challenging and even overwhelming. The important information below can help ensure you are not surprised later about your hospital and physician charges and associated medical bills.
Please know our billing representatives are here to help you with any questions you may have, call 914.666.1701.
Insurance Plans and Your Benefits
- Each insurance carrier offers many different plans - each with its own benefits and limitations.
- Your insurance carrier is responsible for informing you of your plan’s reimbursement for out-of-network providers and services.
- The Hospital’s participation with the insurance carrier does not guarantee 100% coverage.
- You may be responsible for a deductible, co-insurance and/or co-payment.
- It is possible that multiple physician/provider(s) may be involved in your Hospital care.
- Physicians providing services at the Hospital may be independent or they may be employed or contracted by the Hospital.
- All physicians bill separately from the Hospital.
- It is also possible that the physicians involved may or may not participate in the same plans as the Hospital. This includes physician contracted groups, such as anesthesiologists, emergency physicians, pathologists, radiologists and radiation oncologists that provide services at the Hospital.
- Make sure you ask the physician responsible for your Hospital care to provide you with the name, specialty and contact information of any other physician(s) who will be involved in your care.
- It is your responsibility to check with your insurance carrier or with the physician’s office to verify if the physician(s) is covered by your plan.
- For all non-emergent services, if the physician does not participate in your health plan, the physician, upon your request, must provide an estimated amount of what you will be billed for the service.
Helpful Lists - click below
Understanding Healthcare Prices, A New York State Consumer Guide
This consumer guide to healthcare prices was prepared for you by the Healthcare Association of New York State. You'll find answers to questions on healthcare prices, how to compare prices, and how to understand your out-of-pocket healthcare costs. You can view, download and print Understanding Healthcare Prices, A New York State Consumer Guide
Glossary for Sample Bill (Statement)
This glossary of terms was prepared to help you understand your bill or statement.
Account number (visit number) — The unique reference number assigned to each hospital encounter.
Adjustment — A transaction that increases or decreases your accounts receivable balance. A debit increases your balance and a credit decreases your balance.
Assignment of benefits — An agreement in which you instruct your insurance organization to pay the hospital, physician or medical supplier directly for your medical services. Your insurance organization decides the payment rate and your responsible portion.
Balance — Amount outstanding on your account. Your statement will indicate who currently owes the balance.
Claim — A form submitted to the insurance organization for payment of benefits.
Co-insurance — The part (usually a percentage) of the covered health care cost for which you are financially responsible. Often, co-insurance applies after you meet your deductible.
Coordination of benefits — How insurance organizations determine the primary payment source when you are covered under more than one insurance organization or group medical plan. Many insurance contracts state that if you are covered under more than one insurance plan, benefits will be coordinated so that total benefits paid will not be more than 100 percent of the bill.
Co-payment — The contractual provision that requires you to pay a specific charges for specific service, usually when you receive the service. A co-payment usually applies to office visits, prescriptions, and emergency or hospital services.
Covered services — Specific services or supplies for which you’re insurance reimburses you or pays your health care provider. These consist of a combination of mandatory and optional services and vary by state.
Deductible — The agreed amount you must pay before your insurance organization will pay a claim. Usually, you have 12 months to meet your deductible. Eligible expenses after you meet your deductible are then paid for the rest of that 12-month period.
Group number — The number of your insurance organization group. See your insurance card.
Guarantor — The individual responsible for paying this bill. Patient statements are addressed to this person.
Nonparticipating health care provider — A health care provider who is not under contract with an insurance organization to accept patients and receive the insurance organization's approved amount on all claims. You pay the difference between its approved amount for a service and this health care provider's charge.
Participating health care provider — A health care provider who contracts with an insurance organization to accept patients and receive the insurance organizations approved amount on all claims.
Policyholder — The name of the person who took out or purchased the insurance policy. This person owns the policy. Also called a subscriber.
Policy number — The number on your insurance policy. See your insurance card.
Preauthorization (precertification) — The process of getting permission from your insurance organization for certain services before they are provided so that the services can be considered eligible expenses. Usually required for hospital and outpatient services.
Primary insurance — The insurance organization with first responsibility for paying eligible insurance expenses for your medical service (after you have paid your deductible and co-payments). If you have additional insurance, those organizations would work with your primary insurance organization to cover eligible expenses according to your insurance policies.
Referral —Written authorization from your health care provider to see another health care provider. For example, your primary care provider may provide written authorization for you to see a specialist.
Secondary insurance — The insurance organization with second responsibility for paying eligible insurance expenses for your medical service (after you've paid your deductible and co-payments). This insurance would work with your primary insurance organization to cover eligible expenses according to your insurance policies. This insurance organization is billed second — after your primary insurance organization has been billed.
Subscriber — The person who purchased the insurance. Also known as a policyholder or guarantor.
Tertiary insurance — The insurance organization with third responsibility for paying eligible insurance expenses for your medical service (after you've paid your deductible and co-payments). This insurance would work with your primary and secondary insurance organizations to cover eligible expenses according to your insurance policies. This insurance organization is billed third — after your primary and secondary insurance organizations have been billed.