Billing Information
Medical billing is complex and can be difficult to understand. This page has information about the billing process and definitions of terms that are frequently used in medical billing to help you better understand how the billing process works.
Before Your Visit
Registration
At registration or check-in, our staff reviews your information so that we can provide a positive experience through the course of your care and the billing process that follows.
To aid in the billing process, registration staff ask for your updated insurance coverage information and clarify any need for pre-authorization according to your insurance policy.
In some cases, our staff access information online through your insurance company to verify copay, coinsurance, deductible and other self-pay responsibilities that need to be collected before you see a healthcare professional. 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.
Privacy
We're committed to:
- Maintaining the privacy of your health information
- Providing you with a notice of our legal duties and privacy practices with respect to health information we collect and maintain about you
- Abiding by the terms of this notice
- Notifying you if we're unable to agree to a requested restriction and, in most cases, allowing 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'll 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'll offer you a copy of the current notice in effect.
Price Estimates
Our easy-to-use price estimate tool creates a custom estimate based on the service you're seeking, your insurance information, and the Carilion location where you'd like to receive care. To learn more, visit CarilionClinic.org/pricing.
After Your Visit
Coding
After your visit or your hospital admission, our clinical staff coordinates with our 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.
Medical Records
Carilion Clinic offers MyChart, an online healthcare management tool, that offers secure, 24/7 access to your health information and it also enables you to:
- Review medical history, including medication, immunization and allergy information
- Pay bills and review your billing account summary
- Receive test results online–no waiting for a phone call or letter
- Communicate with your doctor securely online
- Request refills of medications
- Request and manage appointments
- Manage a loved one’s health information through proxy access
You may also request copies of your health information, in writing, from medical records personnel at the Carilion Clinic facility that provided your treatment.
Claims Processing
Claims are submitted to insurance companies consistent with the latest government guidelines and payor-specific requirements. Most claims are submitted electronically to reduce error and delay.
Coordination of Benefits (COB) Notices
You may occasionally receive a coordination of benefits (COB) request from your insurance company. This is an attempt on the part of your insurance company to ensure they don't pay for 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 won't pay for your claim until they receive a response from you.
Explanations of Benefits (EOB) Notices
For each claim submitted on your behalf, you may receive an explanation of benefits (EOB) from your insurance company (unless you're covered by Medicaid). Medicare patients may receive a quarterly Medicare summary notice.
The EOB shows specifics of your policy, including the amounts your insurance company will and won't pay. You're likely to see payments, adjustments (including discounts applied based on your insurance network) and amounts you are or aren't responsible for paying.
EOBs also show when payment has been denied (generally based on policy exclusion). While we usually receive a copy of your EOB as well, you'll likely receive your copy before we receive ours and before it's available to be viewed in our customer service areas.
Insurance Follow-up
If your account balance isn't paid 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 was transmitted accurately and make appropriate corrections for possible resubmission. Once all appropriate follow-up efforts are made with participating insurance coverage, and if there's still any balance due on your account, we send statements to you for final resolution of the account.
Billing Statement Cycle
Initial statements are mailed according to any balance due after insurance has processed applicable payments. That means we won’t bill you until we've applied payments from your insurance company (based on the information obtained when you received service).
You may receive more than one bill. Hospital, physician, lab, transportation, dental and other services bill separately depending on where and how the services are delivered. A single hospital visit may result in multiple billing statements.
Payment for the balance due on your initial billing statement is expected when you receive the bill. If you suspect an error or want to discuss payment options, find the contact information for our billing office listed on your statement.
Customer Service and Payment Services
Our customer service team is here to help you with any billing questions. If you have a self-pay balance on your account that hasn't been paid within 30 days, you may receive a letter and a phone call from a payment specialist to assist with resolution of your account. Our patient services representatives will help you understand 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.
Extended Payment Plans
Extended payment options are available through MyChart. You'll need to create a MyChart account, if you don't already have one.
Financial Assistance
We provide financial assistance to eligible patients who receive emergency or other medically necessary care from us in any of our hospital facilities and/or from our healthcare professionals. Financial assistance is only available for eligible services billed by Carilion Clinic.
Generally, you are eligible for some form of assistance if your family income is at or below 500 percent of Federal Poverty Guidelines (FPG). We also consider your liquid assets (for example, cash) and real estate when considering your eligibility.
The Financial Assistance policy should have no impact on the collection policies and practices with regard to those balances that don't qualify for financial assistance. Failure to honor payment for amounts exceeding the financial assistance adjustment may result in the total financial assistance being revoked.
See our Financial Assistance Page for more details about our Financial Assistance Policy and for resources, including links to the Financial Assistance Application form.
Collection Process
We 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's 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're advised of the various methods available to you to settle your account. We accept Visa, MasterCard and Discover on our Carilion Bill Pay site—or you may apply for extended credit through your bank. Financial assistance is available to those patients who don't have the financial resources to pay.
Should you decide not to take advantage of the various methods outlined above, we 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.
Refunds/Credit Accounts
Should a credit result on your account, we will process a refund. A special team in our Patient Financial Services office reviews and processes such accounts full-time to determine where credits must be refunded. We review whether the credit balance is due to your insurance company or to you. This review also includes 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 hold the 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.
