Billing Procedures and Insurance Information at The Miriam Hospital
The following information is intended to help you understand the billing and insurance aspects of your visit to The Miriam Hospital. Please remember to bring a copy of your insurance card with you to the hospital. We encourage you to read this section and to contact us with any additional questions.
Your room charge includes general nursing care, meals, common medications and services (housekeeping and maintenance, etc.). Special prescriptions, treatments and tests ordered by your doctor will be itemized on your bill. Surgical patients are charged for the use of the operating room and anesthesia supplies.
Certain charges are not billed by the hospital and do not appear on your statement. These include the fees of your personal physician, the anesthesiologist, the radiologist or a private duty nurse. These fees are billed directly to you by the individual physician or private duty nurse. Ambulance services are also billed directly to you.
Patient financial services will be pleased to answer any questions you have regarding your bill.
You or a member of your family may talk with a representative by calling the direct line at 1-800-884-6966. Office hours are 9 a.m. and 4:30 p.m., Monday through Friday.
Common Billing Questions
When you arrive at The Miriam Hospital, our registration staff will ask you for your health insurance information. Please make sure you give all your up-to-date information so that your insurance will be billed correctly. At the end of your visit, we will bill your insurance company for all covered services you received. Once we receive payment from your insurance company, we will bill you for any balance remaining or for any services not covered by your policy. We ask that all payments be made within 30 days.
Please be prepared to make payment for deductibles and/or co-payments when you register or are admitted to the hospital. For scheduled/elective services, a financial counselor may contact you in advance to arrange for payment prior to receiving services.
The Miriam Hospital accepts major credit cards, checks or cash.
The Miriam Hospital offers financial assistance programs to patients who meet specific guidelines. Please note that copies of your tax returns, W-2 forms and other documents may be required when you apply. If you are not insured or insured for only part of your expenses, please talk with one of our financial advocates. They can help you establish a payment plan or apply for financial assistance. To set up a payment plan or to apply for financial assistance, please call 401-793-2206. The Miriam Hospital treats all people who need care, regardless of ability to pay.
Prior to your hospital visit, you should confirm that your insurance plan is accepted at The Miriam Hospital. We participate in most major insurance plans. If you have any questions about which insurance plans The Miriam Hospital accepts, please call our financial advocates at 401-793-2206.
You should know which charges your insurance company will pay and which ones will be your responsibility. Examples of services you should confirm are covered by your plan include:
- Routine physicals and examinations
- Screening tests for some age-related illnesses or for inherited diseases when symptoms are not present
- Tests to rule out potential problems when no symptoms are present
- Testing or treatment of chronic diseases
- Experimental treatments and testing
- Cosmetic surgery
If you are having elective inpatient or outpatient services, a financial counselor may contact you in advance to arrange for payment prior to your surgery. In cases involving worker’s compensation, you should talk to your employer to determine your financial responsibility.
It is important that you are aware of any restrictions and/or regulations in your health insurance policy. Typically, prior approval is needed before you can be referred to a specialist or admitted to a hospital. You should check with your insurance company to see if they require any of the following:
- Second surgical opinion before you can undergo surgery
- Notification within 24 hours if admitted to a hospital on an emergency basis
- Any other limitations or regulations requiring approval forms, etc.
If your insurance company has such regulations, please follow your insurer’s instructions and obtain the necessary approvals. If you have any questions regarding your insurance coverage, please contact your insurance company or speak with one of our financial counselors.
Hospitals have a chargemaster, a comprehensive list of all items that can be billed to a patient or insurance provider. Although these charges are rarely paid due to the discounts negotiated by private insurers, hospitals use them as a starting point for billing in order to comply with federal regulations.
EOB stands for Explanation of Benefits. It is not a bill; it simply explains your insurance coverage.
Yes, you could receive other bills in addition to your hospital bill. These may include charges for physician services, private duty nurses and/or specialists who consult in your care, such as radiologists, pathologists, or anesthesiologists.
Not all insurance policies are the same. You should check with your insurance company to see what your particular policy covers.
Although this may seem repetitive, we may not always have your most recent insurance and/or personal information.
Your health insurance and demographic information needs to be verified for accuracy to prevent denials from your insurance company.
Absolutely! For the hospital to bill appropriately, we need your correct insurance information.
The hospital must bill your insurance company prior to billing you. This process could take months to complete.
To receive a copy of your medical record, you need to complete an authorization form, which can be obtained from the health information services department, located at The Miriam Hospital’s main building. You will be notified if there is a fee associated with your request. Requests for medical records may take up to 30 days to process. You can call 401-793-2222 for more information.
The Miriam Hospital accepts major credit cards, checks, or cash. You can send your payment in the envelope that accompanies your bill or you can pay your bill at the main cashier’s office (located in the main lobby) Monday through Friday from 8 a.m. to 4 p.m.
The Miriam Hospital Cost of Care and Price Transparency
Part of being a well-informed patient is learning all you can about the treatment or procedure you will undergo. Also important is knowing the costs involved, how much you may be responsible to pay, and how much other hospitals or medical facilities charge for the same care. To keep patients fully informed, The Miriam Hospital publishes the charges for its services online.
Professional Review Organization
Federal law requires that all medical care paid for by Medicare be reviewed by a professional review organization. Blue Cross, Medicaid and other insurers also require similar reviews prior to payment of bills. These reviews are performed to ensure that the highest quality health care is rendered at the lowest possible cost.
If it is determined that you no longer require the acute level of care provided by The Miriam Hospital, you and your physician will be notified. Your insurance carrier may not continue to pay your benefits and other arrangements will need to be made.