PATIENT INFORMATION GUIDE
GENERAL FINANCIAL INFORMATION

Patient Financial Services (PFS) and Patient Access
When you are admitted to the hospital for services, there is important information you need to understand about the financial responsibilities related to your stay. We hope you find this information helpful:

• Pre-registration
• Registration
• Valuables
• Insurance
• Self-Pay
• Medicare/Medicaid
• Financial Arrangements
• Financial Assistance
• Hospital Billing
• Physician Billing
• Discharge Process
• Management
• Patient Complaint Resolution

Pre-Registration

If your service is scheduled in advance, we will attempt to contact you to verify and update any incorrect data, such as address, place of employment, insurance, etc. We will also ask that you pay your co-pay/deductible and/or coinsurance at the time we pre-register you.

Registration (Patient Access)

We want your registration process to go as smoothly as possible. That is why we have a guide to help ease the process.

Please remember to bring with you at the time of registration the following items:

• All active insurance cards
• Picture ID
• Physicians Orders
• Payment for any copays or deductibles that are due
• If you have an Advance Directive such as a Living Will or Durable Power of Attorney for Healthcare, please
• ng it with you for inpatient stays and surgeries.

Registration will consist of the following:

• If we were unable to pre-register you, we will confirm your address, telephone number, place of employment and insurance information.
• Verification that pre-certification has been obtained.
• Collection of payments not paid at time of pre-registration.
• Order any test(s) requested by your physician.
• Obtain your signature for Consent for Treatment, Authorization to bill your insurance and that you understand Coosa Valley Medical Center is not responsible for any personal items.

Valuables

Neither Coosa Valley nor its employees accept responsibility for the personal belongings (property) of the patient. We ask that you leave your property with person(s) other than Coosa Valley Medical Center and its employees. If you do choose to keep your property, you cannot hold Coosa Valley Medical Center or its employees responsible while it is in your possession or during any time when it is not in your possession.
Coosa Valley Medical Center assumes NO responsibility for lost or damaged valuables. Therefore, we ask that other than sufficient funds to meet your co-payment/deposit requirements, you leave all other valuables at home.
If this is an unscheduled stay, please send ALL items home immediately with a family member to ensure their safety. Coosa Valley Medical Center does not reimburse for lost, stolen or damaged items.

Insurance

Your co-pay, deductible and/or co-insurance are due at time of service. Payments can be made by cash, debit cards, personal check, travelers check, or by credit card (VISA, MasterCard and Discover).

If we do not have the exact amount due at time of service, we will require a deposit. The deposit may vary, depending on the particular type of service.

INSURANCE NON-CONTRACTED WITH COOSA VALLEY MEDICAL CENTER
(Refer To Your Benefit Plan)

If your insurance is not contracted with Coosa Valley Medical Center, your financial responsibility may be significantly higher and is due at the time of service.

Self-Pay

Coosa Valley Medical Center, as a licensed healthcare facility in the State of Alabama, gives notice, that it is required, prior to provision of non-emergency medical services, to give its patients good-faith estimates of reasonably anticipated charges for their treatment. Patients are also entitled to notification of revisions to the estimates. Estimates may be the average charge(s) for the anticipated procedures, and actual charges may exceed the estimates. To obtain an estimate, please call 256-401-4017 or 256-401-4018 or you may email your request to a Financial Counselor at financial.counselor@cvhealth.net.

Financial assistance may be available to patients receiving non-elective hospital services who are not covered by any form of insurance or governmental program. Verification of income and financial information will be required. Please contact a Financial Counselor for further information.

If your insurance requires precertification, and you are scheduled for a procedure or test, it is the responsibility of your physician to obtain the authorization from your insurance company. If you have any questions regarding precertification, please let us know. If your physician is unable to obtain precertification, we may need to cancel or reschedule your service(s).

Your insurance coverage is a contract between you and your insurance company. Benefits will vary depending upon the type of insurance policy you carry.

Medicare/Medicaid

Coosa Valley Medical Center is a Medicare/Medicaid provider. Medicare and Medicaid patients must present their current cards at the time of service. Medicare patients are requested to pay their deductible at the time of admission. Medicaid patent’s eligibility will be verified.

Medicare patients should be prepared to pay their Inpatient deductible at the time of admission.

Medicare patients, we are required by Medicare to check the diagnosis information that your ordering physician has provided with the specific test or procedure he/she has ordered when you are scheduled for Outpatient services. In some cases, Medicare will not pay for a service because they feel that the diagnosis does not support the need for the test or service requested by your physician.”

Please have your insurance card(s) and proof of identification readily available.

Financial Arrangements

Payments are required at the time of service for any amount not completely covered by your insurance. Items such as your deductible and co-payment will be considered as deposits due at the time of service. Estimated deposits are based on average charges per procedure or diagnosis.

For patients without insurance, payment of the estimated hospital bill, less the deposit made at the time of service, is due at discharge.

If you have financial difficulties and cannot make the full payment at discharge, please request to see a Financial Counselor as soon as possible. A Financial Counselor can help arrange an alternative for payment.

Payments by cash, check, VISA, MasterCard and Discover are accepted. Your Financial Counselor can provide you with additional information on the various payment options. If payment in full for services is not received, Coosa Valley Medical Center offers a payment plan option to assist our patients in settling their accounts.

Financial Assistance

Financial assistance may be available to patients receiving non-elective hospital services who are not covered by any form of insurance or governmental program. Verification of income and financial information will be required. Please contact a Financial Counselor at 256-401-4017 or 256-401-4018 or by email at financial.counselor@cvhealth.net for further information.

Hospital Billing

Your medical insurance coverage is a contract between you and your insurance company. You are responsible for your hospital account. Payment may be made by cash, personal check, MasterCard, VISA, and Discover.

Physician Billing

You should expect to receive a separate bill from the physician that may assist in determining results of your service(s).

Physicians are not employees or agents of Coosa Valley Medical Center. They are independent, private practicing physicians and may be individually contracted with an HMO or PPO. These contracts could be different from contracts Coosa Valley Medical Center holds.

Contact your insurance company to verify that both the Hospital and the physician is contracted with your Insurance Provider Network. You should expect to receive a separate bill from your physician(s) listed below, if applicable. If you have any questions regarding bills from them, please contact them directly.

• Emergency Physicians will bill you for any services you may have received in the Emergency Department.
• Radiologists will bill you for reading any X-rays that were taken while at the hospital.
• Consulting Physicians may be asked by your treating physician to review your care for any special needs. You will receive a bill from these physicians as well. If you have any questions about why they are billing you, please speak with your physician.
• Pathologists will bill you for any laboratory and pathology test(s) they have read while you were at the hospital.
• Anesthesiologists will bill you for services received during any surgical procedures you may have undergone while at the hospital.

Discharge Process

At time of discharge, patients are required to meet with a Financial Counselor if account balance is unsettled. Coosa Valley Medical Center offers courtesy discharges to all patients who settle balances due prior to release from hospital.

Management

If you have any questions, issues or comments, please feel free to contact Pam Waters, Patient Access Manager 256-401-4019 or Darlene Nelson, Director - Patient Financial Services 256-401-4020.

Patient Complaint Resolution

If you have any concerns about patient care and safety that the Medical Center Staff has not addressed during your visit, you are encouraged to contact the Administrator on call for Coosa Valley Medical Center or any member of the hospital’s Management Team.

If your concern cannot be resolved through the Medical Center, you may contact the Joint Commission’s Office of Quality Monitoring to report any concerns or register a complaint by either calling 1-800-994-6610 or emailing complaint @jcaho.org.