Emergency Billing Frequently Asked Questions

John C. Lincoln Health Network is committed to providing the best care possible for patients of our emergency departments.

Good communication is an important part of patient care. For this reason, we are providing this list of commonly asked questions about how we bill for emergency visits.

Frequently asked questions:

Is there a law requiring payers to pay for emergency or trauma services?

There isn't a single statute governing how payers pay claims. The contract between the payer and the individual or group may stipulate what is covered and what is not covered. There are federal and state statutes governing Medicare, Medicaid, Employer Benefit Plans and other types of Insurance.

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Why wasn't I told my insurance was out-of-network for the hospital or physician?

The federal law — EMTALA — prevents any financial discussion prior to a medical screening exam and treatment regardless of ability to pay.

Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition." If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.

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Why wasn't the hospital bill paid in full or at a contracted rate?

Hospitals do not contract with every payer, and your payer may not be contracted with the hospital.

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Why wasn't the physician bill paid in full or at a contracted rate when the hospital was paid in full?

Physicians are not employees of the hospital and submit their billing separately from the hospital. They may not be contracted with the payer.

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Why isn't the physician contracted with my insurance?

Each physician or group is an independent business and contracts with payers on their own.

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What can I do about getting the physician bill paid?

There are a couple things you can do:

  1. Review your benefit booklet and contact the payer with questions. Payers generally have an appeal process. Most payers will reconsider benefits when the policyholder appeals and documents the circumstances involved (i.e., the ambulance took you to the nearest provider to treat your degree of injury).
  2. Contact the physician's billing office and ask if they will accept a reduction based on the circumstances. If your coverage is through a group health plan, contact your employer's benefit department. They may be able to assist you in resolving the problem.

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