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Billing & Insurance

Hospital Charges

Hospital charges for all patients include a daily rate that covers the cost of 24-hour nursing, room accommodations, meals, linen, telephone, housekeeping staff and other services. This daily rate does not include fees for the services of your personal doctor or of other doctors consulting in your care. Additional charges are also made for special services you receive, such as medicines, laboratory tests, radiology (X-ray) procedures, physical therapy treatment, etc., ordered by your doctor. In healthcare, unpaid accounts become part of the cost of service, which, ultimately, must be carried by all people paying for services. In an effort to contain costs for all patients, UPMC Hamot has adopted a collection policy that is consistent with normal healthcare practices in this community.

Physician Charges

Medicare and Medicaid regulations prohibit combined billing of hospital services with services provided by doctors. Doctors on UPMC Hamot’s staff are private practitioners and are required to bill separately for their services. Separate bills will be sent to you for treatment, consultation and professional review by:

  • Your Own Doctor
  • Anesthesiologist
  • Pathologist (Laboratory)
  • Radiologist (X-ray)
  • Other Consultants Brought in By Your Own Doctor
  • Emergency Department
  • Imaging

Look on your bill for contact information and the billing address if you have any questions.

Insurance

As a service to our patients, UPMC Hamot automatically sends a copy of your bill to your insurance carrier approximately five days after you are discharged from the hospital. Your hospitalization policy is a contract between you and your insurance company. While the hospital will cooperate to the fullest in expediting your claim, you are ultimately responsible for your account.

Charges billed to your insurance carrier and not paid within 45 days of receipt of the bill become your responsibility.

Not all groups or private insurance provide full coverage of hospital stays, and the hospital has no control over the provisions, coverage or benefits of your plan. We encourage you to verify your benefits before your stay at UPMC Hamot by contacting either your insurance company or the employee benefits counselor where you work.

If you have no insurance or limited coverage, you will be expected to make a cash deposit based on an estimate of the charges for treatment of non-emergencies. Regardless of your financial situation, you will be admitted for treatment.

Charity Care Policy

UPMC Hamot has a charity care policy available for those people meeting certain eligible guidelines. For more information, call 814-877-6146.

Questions About Your Bill

If you have questions about a bill, you can access UPMC Hamot’s Casnet System, a voice-activated system that answers the most common questions received by the UPMC Hamot Patient Accounting Department. Call 814- 877-6146 to learn your account balance, the date your insurance was billed or to order an itemized statement of your account. There is also an option that allows you to speak directly with one of our financial account representatives, if you choose.

Payment Options

UPMC Hamot accepts cash, personal checks, MasterCard, VISA and Discover. Term payment plans are available after a determination is made of your financial resources.

If you choose, you can make payments online with our Online Bill Pay option. You will need to have a copy of your bill as you will be prompted for questions requiring certain pieces of information.

Utilization Review

Utilization review is a process that keeps the cost of your care down while maintaining access to and quality of the services provided by UPMC Hamot.

Pre-certification is an important part of this review process and is required by many insurance companies and health plans. It allows the reviewing agency to determine if the medical services you require should be performed in an inpatient or outpatient setting.

If your insurance coverage contains this requirement, you must notify your insurance company of any planned admission prior to coming to the hospital.

Emergency admissions must be called within 24 to 48 hours after they take place.

While you are a patient in the hospital, the care and services you receive are subject to continued review in order to ensure high quality. Because your insurance company and other third-party payers (Medicare and Medical Assistance) will pay only for hospital care that is medically necessary, you will be notified if the review shows that the hospital care is no longer appropriate. The decision to discharge you, however, always rests with your doctor. But, if you choose to stay in the hospital beyond the allowable time, you will be responsible for all expenses that are not paid by the third-party insurer.

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