For many patients and their families, a visit includes filling out unfamiliar forms, and answering financial and insurance questions. The information below can help with this process.

St. Luke’s Cornwall Hospital will honor assignments of insurance benefits for 45 days from the date of billing to the insurance company. If, at the end of 45 days, the insurance company has not settled the account, St. Luke’s Cornwall Hospital will look to the patient for the final settlement. Any patient having inadequate insurance coverage, or no insurance coverage, will be requested to make appropriate deposits at the time of admission.

St. Luke’s Cornwall Hospital is a participating hospital provider in many managed care organizations. Note: Failure to provide accurate and current insurance information and required referrals when you are admitted could result in penalties or a reduction of benefits by your insurance company.

General Information About Most Types of Health Insurance Coverage

Managed Care, Health Maintenance Organization (HMO) Insurance

Benefit and coverage rules and policies differ from carrier to carrier and plan to plan. It is critical, therefore, that subscribers know the specifics of their plans.

Examples of rules and policies include:

• Choosing a Primary Care Provider (PCP) to manage the subscriber’s healthcare needs and related issues.
  
• Understanding the PCP’s role in coordinating the subscriber’s health-related needs.
  
• Obtaining the appropriate authorizations, referrals and documentation, as needed. Likewise, subscribers must familiarize themselves with coverage exclusions. · Many managed care or HMO carriers have co-payment or deductible requirements for healthcare services.

St. Luke’s Cornwall Hospital strongly recommends patients read, question and ultimately understand the provisions and policies, to reduce or eliminate financial penalties imposed by the insurance carriers for non-compliance of insurance plan rules and policies.
If you are enrolled in a managed care or HMO plan through an employer, your Human Resources Department should assist with your individual benefits.

Commercial or Indemnity Insurance Plans

Standard commercial or indemnity insurance plans often give subscribers the freedom to see any physician affiliated with any facility, with little or no financial penalties.

These insurance plans frequently have co-payments, deductibles and/or “out-of-pocket” expense policies, which may result in balance billing by physicians and hospitals. All patients/subscribers should familiarize themselves with policy coverage details and rules, exclusions, etc. that may result in patient financial responsibility.

Many commercial insurance plans require that forms be completed before they consider payment. Please refer to your individual policy for further details.

Medicare Part A & B

If you are age 65 or older, have End Stage Renal Disease, or are permanently disabled receiving Social Security Disability Insurance, you may qualify for Medicare benefits. Medicare Part A provides benefits for in-patient hospitalization; Medicare Part B for ambulatory surgery, emergency services, physicians’ services and outpatient diagnostic testing. Your Medicare card will indicate if you have Part A benefits, Part B benefits or both and their effective dates. Effective August 2000, Medicare Part A payments to hospitals are based upon the services rendered. Medicare Part A has pre-determined your co-payment responsibility for each covered procedure or test performed on an outpatient basis in a hospital. In most cases, your co-payment is significantly lower than under the previous reimbursement.

Questions about specific benefits should be directed to Empire Medicare, toll free, at 1-800-442-8430, or through the Internet at www.empiremedicare.com.

Medicaid

Medicaid is a state-run health care system for patients not covered by other healthcare insurance. Eligibility is dependent upon earnings, family size, and other criteria determined by social services. · Medicaid covers almost all aspects of healthcare: emergency room treatment, in-patient hospitalization, outpatient diagnostic testing, ambulatory surgery, etc. Some services are subject to patient co-pay amounts from $.50 to $25.00. · Anyone who believes he/she may be eligible for Medicaid must apply at his/her local Department of Social Services branch. · Over the next few years, almost all Medicaid recipients will be enrolled in some type of managed care program. The benefits offered by these programs/carriers are very similar to those offered by traditional Medicaid, but subject to the rules and regulations of managed care and HMO policies, i.e. primary care physician selection, referrals and authorization for services, etc.

Patients enrolled in Medicaid managed care programs are often restricted as to which facility they may seek for non-emergent treatment. Medicaid beneficiaries should contact their local Department of Social Services for more information on Medicaid benefits, coverage and managed care options.

Charity Care

As a not-for-profit hospital, St. Luke's Cornwall Hospital is dedicated to our mission of providing quality health care to the people of our community. In emergency situations, every patient is treated, regardless of the ability to pay. Care first is at the core of our SLCH philosophy. In non-emergency situations, we are committed to working with patients so that quality care comes before finances.

For patients without health insurance or those that may not be able to pay in full for their health care, we offer a charity care program. SLCH provides financial aid to patients based on their income, assets, and needs. We also assist patients in obtaining health insurance if they qualify, and can work with patients to arrange a manageable payment plan. SLCH staff is available to give you the help and support you need to make your hospital experience a pleasant one.

It is important that you contact us if you cannot pay your hospital bill; federal and state laws require all hospitals to seek full payment on patient accounts. Clear communication is important to this process; if we are not notified of a financial issue your unpaid bills may be turned over to a collection agency, which could affect your credit rating.

For more information, please contact our Collections Department at (845) 458-4925 or (845) 458-4905. Your account will be handled with confidentiality and courtesy by our staff of professionals.