Understanding medical billing can be a difficult task for any patient or caregiver. We understand many unique circumstances may arise and cause a number of questions. Some overall detail regarding our billing process follows, but you may also access our most frequently asked billing questions.
Below you will find information about the following topics:
- Service Pricing Estimation
- Medical Records
- Claims Processing
- Coordination of Benefits (COB) Notices
- Explanations of Benefits (EOB)
- Insurance Follow-up
- Billing Statement Cycle
- Customer Service and Payment Services
- Interpreter Information for Billing Questions
- Extended Payment Plans
- Charity Care
- Collection Process
- Refunds/Credit Accounts
Prior to Your Visit
The time of registration or check-in for your visit will be used by Carilion Clinic staff to obtain information that will ensure a positive experience through the course of your care and the billing process that follows. To aid in the billing process, registration staff will obtain updated insurance coverage information and clarify any need for pre-authorization according to your insurance policy. In some cases our staff will access information online through your insurance company to verify Co-pay, Coinsurance, Deductible and other self-pay responsibilities that may be collected before you see a provider. Payment of these out-of-pocket costs prior to service allows you to free yourself from concern with receiving a bill or wondering if your account has been resolved after your visit. We find this particularly helpful to patients expecting an inpatient stay or procedure involving some recovery time. Following such services we hope to free you from billing concerns so you can focus on what matters most to you.
Carilion Clinic is committed to:
- Maintain the privacy of your health information.
- Provide you with a notice of our legal duties and privacy practices with respect to health information we collect and maintain about you.
- Abide by the terms of this notice.
- Notify you if we are unable to agree to a requested restriction and, in most cases, allow you to request a review of our decision.
We reserve the right to change our privacy practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will amend this notice. The notice will contain, on the first page, the effective date. In addition, the first time you register at or are admitted to a facility for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
Price estimates of gross charges are prepared upon request through our Price Line at (540) 224-5123. These are only estimates based on the best information available at the time and may not identify all charges that may be incurred. Depending upon your unique medical conditions and treatment needs, actual charges may vary greatly from the estimate you receive. It is important for patients to familiarize themselves with any insurance benefits that may be applied to reduce out-of-pocket responsibilities. Uninsured patients may qualify for discounts arranged with our Financial Counselors and Medical Office Associates with payment at the time of service.
Following Your Visit
Following your visit or admission, clinical staff will coordinate with certified coding personnel and/or trained charge entry staff to verify the services billed reflect the services documented in your medical record. These services are entered in our billing system where claims are generated to submit bills according to the insurance coverage information obtained during your registration.
Carilion Clinic now offers MyChart, an online healthcare management tool, in various primary care medicine practices. MyChart offers patients secure, 24/7 access to their health information and it also enables them to:
- Review medical history, including medication, immunization and allergy information.
- Receive test results online - no waiting for a phone call or letter.
- Communicate with physicians securely online.
- Request refills of medications online.
- Request an appointment online.
Otherwise, you may request copies of your health information, in writing, from medical records personnel at the Carilion Clinic facility providing your treatment.
Claims are submitted to insurance companies consistent with the latest government guidelines and payor-specific requirements. A majority of these claims are submitted electronically to reduce error and delay.
Periodically, and depending on other information your insurance company maintains, you may receive a Coordination of Benefits (COB) request. This is an attempt on the part of your insurance company to ensure they do not pay toward a claim that will be paid through some other form of coverage. It is very important to respond to COB letters as soon as possible to avoid delay in the payment process. Most companies will not complete processing of your claim until they receive a response from you.
For each claim submitted on your behalf, you may expect to receive an Explanation of Benefits (EOB) from your insurance company (Medicaid excluded). Medicare patients may receive a quarterly Medicare Summary Notice. This EOB will be a reflection of the specifics of your policy, showing what your insurance company will and will not pay. You are likely to see Payments, Adjustments (including discounts applied based on your insurance network) and amounts you are or are not responsible for paying. EOBs will also indicate when payment has been denied (generally based on policy exclusion). While we generally obtain a copy of your EOB as well, you will likely receive your copy before we receive ours and before it is available to be viewed in our customer service areas.
Should an account balance not be resolved in a timely manner based on our claim to the insurance coverage you provided, a member of one of our specialized Insurance Follow-up teams will review the account in detail to ensure information transmitted accurately and make appropriate corrections for possible resubmission. Once all appropriate follow-up efforts have been made with participating insurance coverage, and if there is any balance due, statements may process to you for final resolution of the account.
Initial statements are mailed according to any balance due after insurance has processed applicable payments. That means we won’t bill you until we have applied payments from your insurance company (based on the information obtained when you received service). You will find that some Hospital Billing Statements currently process separately from physician’s Professional Billing Statements as well as Laboratory, Transportation, Dental and other service lines. This is based on the provider of services and location where those services were provided. It is valuable to note that one admission to a hospital may result in a number of such billing statements. Payment for the balance due on your initial billing statement is expected upon receipt of the bill. Should you suspect an error or need assistance to pay your bill you will find contact information for our billing office listed on your statement and on our Frequently Asked Questions page.
Our Customer Service team is eager to assist you with any billing questions. Should a self-pay balance due on your account age beyond thirty days you may receive a letter and a phone call from a Payment Specialist to assist with resolution of your account. Patient Services Representatives are committed to assist you in understanding the options that may be available to keep your balance from aging beyond normal ranges. Early resolution of your account allows Carilion to provide service without passing on the cost of your care to other patients.
Carilion Billing Customer Service is committed to assist patients through a variety of language needs. Non-English speaking patients will be assisted through an interpretation service initiated by our Patient Services Representative at the time of the call. Hearing/speech impaired or deaf patients may choose to contact our office through a relay operator using a TTY/TDD. Patients may also choose to submit questions in their native language via email. All patients may use our Billing Customer Service phone and email contacts to access these services.
El servicio de atención al cliente de cobros de Carilion estamos comprometidos ayudar los pacientes con variedades de necesidades de idioma. Pacientes que no hablan inglés serán ayudados por un servicio de interpretación iniciado por nuestro representante del servicio de atención al cliente en el momento de la llamada. Pacientes con deficiencias auditivas/dificultad en el habla o pacientes sordos pueden contactar nuestra oficina por un operador de telecomunicación como TTY/TDD. Los pacientes también pueden enviar preguntas en su idioma nativo por correo electrónico (email). Todos los pacientes pueden usar los contactos del teléfono del servicio de atención al cliente de cobros y del correo electrónico 866-720-3742 para tener acceso a estos servicios.
Adeegyada Macmiilka ee Biilka Rugta Carilion waxaa ka go'an in ay gargaaraan bukaan-socodyada ayagoo buuxinaya baahidooda luqadaha dhowrka ah. Bukaan-socodka aanan Ingiriiska ku hadlin waxaa laga gargaari doonaa ayaga oo la siinayo adeegyada turjumaanka ee ay bilaabayaan Wakiilada Adeegyada Bukaan-socdka marka ay soo wacaan. Sidoo kale bukaan-socodyada waxay dooran karaan in ay su’aalahooda ku soo gudbin karaan afkooda hooyo ayaga oo email ahaan ku soo dira. Dhammaan bukaan-socodyada waxay isticmaali karaan emailka iyo telfoonka Adeegyada Biilka Macmiilka 866-720-3742 si ay adeegyadan u helaan.
Ibitaro vya Carilion, igisata gishinzwe kwishuza ciyemeje gufasha abarwayi cifashijije imvugo canke indimi zikenewe. Abarwayi batavuga ikingereza bazafashwa hifashishijwe ibureau vy’umusobanuzi womu gisata cacu bishinzwe abahagarariye abarwayi mugihe bazoba baterefonye. Abarwayi bafite guhitamo kurungika ibibazo vyabo mu mvugo canke mururimi rwabo rwakavukire bifashishije imeli. Abarwayi bose bashobora gukoresha umurongo wa terefone na imeli vyo mugisata gishinzwe kwishuza 866-720-3742 kugirango babone uko bafashwa.
Extended Payment Plans are available through MedKey. Our MedKey program eases the worry of unexpected medical expenses, allowing you to budget these payments with other monthly expenses. MedKey is available without a credit check and offers 90 days interest free for each service (5.99% APR following that period).
Carilion Clinic is committed to providing quality health care to all regardless of their ability to pay. Our Charity Care Policy is designed to allow relief of all or part of the charges that exceed a patient’s reasonable ability to pay. Carilion uses the Federal Poverty Guidelines (FPG) published and updated yearly in the Federal Register along with a Financial Needs Assessment Questionnaire (FNAQ) as developed by Carilion to determine eligibility. Together, the family income, number of family members living on that income, and equity in real property are pertinent factors in determining how much, in the sole judgment of Carilion, a patient is reasonably able to pay for services. Patients with family income up to 400 percent of FPG with no more than $100,000 equity in real property are eligible for a Charity Care discount. To apply for the Charity Care program complete a Financial Needs Assessment Questionnaire or contact our Billing Customer Service team with questions. All patients who are able will be expected to pay for their own healthcare services to avoid shifting the burden for their care to other patients and the general public. The Charity Care Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify for charity care. Failure to honor payment for amounts exceeding the charity adjustment may result in the total charity care being revoked.
We will notify you of the balance owed on your account by sending you up to three statements and by attempting to call the responsible party. It is your responsibility to provide Carilion with accurate contact information such as your address and phone number so we can continue to communicate with you regarding your bill. During this process, you will be advised of the various methods available to you to settle your account. We accept Visa, MasterCard, and Discover or you may apply for extended credit through your bank or through MedKey. Charity Care is available to those patients that do not have the financial resource to pay. Should you decide not to take advantage of the various methods outlined above, Carilion may place your account with a collection agency or the legal department to collect the outstanding balance owed. This may result in legal action being taken to collect the balance and result in additional calls, letters and increased charges such as interest or court cost. Information about non payment of your account or judgments entered against you may be collected by one or more Credit Bureaus which could affect your credit .
Should a credit result on your account, Carilion is committed to process a refund in a timely manner. A special team in our Patient Financial Services office reviews and processes such accounts full-time to determine where credits must be refunded. Review must be performed to determine if an insurance company might claim such a credit refundable to them or if the credit balance is refundable to you. This review will also include assessment of multiple service lines and serve to transfer credits where other balances may be due. In situations where more recent balances are awaiting payment from insurance we will hold this credit until those balances are resolved. Should you find delay in receiving an expected refund, our Customer Service team can research the status of this review and ensure any credit balance is processed appropriately.