Billing, Insurance & Financial Services

In network means that insurance company has a contract with Stormont Vail Health to provide health care services at a reduced price. Out of network means the insurance company does not have a contract with Stormont Vail Health and you the patient will have higher out of pocket/costs.

A referral is when your pcp (primary care provider) sends you to another provider to receive care/services.  Your insurance may require that you receive care/service from an in network provider.

This is the insurance company determining before the services are rendered if the services meet medical necessity, are a covered benefit/service under your plan.   It is approval from the insurance company before the service is provided.

As you are making your appointment,  you should verify that Stormont Vail Health participates with your insurance.   Say -  “I want to make sure  you are in my network.   My insurance is  (example - Blue Cross/Blue Shield) and my network is ( example  PPO – Blue Choice)  - is Stormont Vail Health an in-network provider. ?

You can call your health insurance plan.  You can typically find their number on the back of your insurance card listed as member services phone number

Use your health insurance plan’s website.  Many offer interactive web tools to help you understand your coverage.

Use your health insurance plans’s mobile app.  Many offer mobile apps to help you understand your coverage.

Be sure to bring your insurance card to your appointment

When calling to check on your plan’s in-network status, here is some important information to help you correctly identify Stormont Vail Health Campus  (hospital in Topeka and Cotton ONeil Clinic)  or   Stormont Vail Flint Hills Campus (Junction City)

Check your plan benefits/covered services against what type of service you will be receiving (e.g., physical therapy, immunizations, primary care visit, psychiatry care, etc.) and where you would like to be seen.

Try to determine the answers to these types of questions:

• Is this healthcare provider in-network?
  • If not, how can I find an in-network provider?
  • If I choose to see this provider anyway (out-of-network), what will my cost be?
• Does my plan provide coverage for this service?
  • Are there limitations or exclusions to my coverage for this service?
  • Does my plan require a Prior Authorization or Referral?
  • Does my plan limit the number of visits that I am entitled to?
  • If I am given supplies as part of my care, will they be covered?
• Will I need to pay a deductible?
  • If so, how much is my deductible?
  • When does my deductible reset each year?
  • Do I have a different deductible for in-network and out-of-network providers?
• Will I need to pay a co-payment or co-insurance? If so, how much?
• Is my prescription plan different than my medical plan?

Does my plan include dental coverage?

Hospital Charges

Daily hospital charges include fees for your:

• room
• meals
• 24-hour nursing care
• other services such as laundry, housekeeping, accounting and security

Charges are based on your room type and the amount of care you need.

Other parts of your hospital bill may include:

• procedures to diagnose or treat your condition
• medical tests
• some supplies and drugs
• services of hospital specialists, such as radiologists and pathologists

We generally bill your insurance company or health plan within two weeks after your discharge. Once your insurance company pays its portion, you will be billed for:

• co-pays and/or co-insurance amounts
• deductibles
• services for which your insurance company does not pay

Physician Fees  -   Clinic Providers

Charges for professional services provided by your physicians (such as hospitalists, ER physicans) and visits to providers in the clinic are billed separately to your insurance company.

Once your insurance company or health plan pays its portion, you will receive one monthly state­ment that will include any hospital and/or physicians’ fees. The statement will show balances such as co-pays, deductibles, or services not covered by your insurance. Any charges not paid by your insurance carrier are your responsibility. Click here for information on Financial Assistance and payment plans.

Here is an example: