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Paying for Your Care
Paying For Your Care

We understand that hospital billing can be very confusing. We’re here to walk you through the process, to answer your questions, and to help in any way we can. If you phone us, you will reach experienced and friendly people who want to help you find the information you need. We understand that when you are injured or ill, healing and recovery are your first priorities. We also know it is easy at times like this to forget, or be overwhelmed, by the business side of medical care. We are here to assist you in the process of settling your bill.  

 

Overview of the Admissions Process

The first stop for every patient, both inpatients and outpatients, is the Admissions Department. There are several ways you might check in to the hospital, and they all start at the admissions desk:

 

You might need emergency treatment, in which case you check in with Emergency Department registration on your arrival at the hospital.

 

Your primary care physician might have ordered pre-admission testing for you. If so, you simply need a brief stop at Admissions.

 

During a visit to your physician’s office, s/he may determine that you should be admitted to the hospital. Your physician will call and make arrangements. When you arrive here, you simply need to stop at the Admissions desk to check in.

 

If you are registering for outpatient services, you may take advantage of express check-in by calling 607-274-4353. If you call ahead 24 to 48 hours, it will help us streamline your check-in. We can verify pertinent information and then when you check in at Admissions, you will be directed immediately to the appropriate department in the hospital.

 

When you check in, the person at the desk will take down (or verify, if your information is already there) all the information needed to get you into the system:  contact information, insurance information if you are covered, etc. 

 

Overview of Insurance Billing & Payment

One insurance policy is not like the next. If you are covered by health insurance, one of several possibilities will apply:

 

  CMC accepts your insurance and the service(s) you seek are covered by your policy.

 

  CMC accepts your insurance, but some or all of the service(s) you seek are not covered by your policy.

 

  CMC does not accept your insurance. 

 

We suggest that you discuss coverage with your employer or your private insurance carrier before you seek treatment at Cayuga Medical Center, both to make certain you are insured and to learn how much of your treatment is liable to be covered by your policy. Any amount not paid by your insurance is your responsibility. We accept cash, personal checks and most major credit cards (American Express, Discover, Visa, & MasterCard). If your insurance policy requires a co-pay, that payment is required upon registration.

 

When you get your bill, if you are unable to pay your entire balance due in a single payment, we will work with you to set up a payment plan. Financial assistance is also available for those who qualify. You may contact us at 1-607-274-4400 to set up a payment plan or to apply for financial assistance, or you can apply for financial assistance online. Click for online financial assistance guidelines and application. Cayuga Medical Center will bill both your primary and secondary insurance carriers, so it is important for you to make sure you have provided CMC with current insurance information.

 

What Your Bill Will Include

Inpatient bills will include:

          charges for hospital tests and services

          room accommodation

          supplies

          drugs

 

Outpatient charges may include:

          emergency room visits

          clinic or therapy visits

          observation or holding bed

          tests

          other services (including lab specimens sent to us by physicians' offices)

          supplies

 

One of the aspects of hospital billing that may seem confusing is that you will receive separate billing statements from all of the doctors who assisted in your care: not only your referring physician but other doctors who may have served as consultants on your case, including emergency room physicians, cardiologists, radiologists or other specialists, for example people who read x-rays or interpret lab tests. You may not even have met these doctors in person, but they assisted in your treatment in some capacity. The bills will not necessarily arrive at the same time because the varying departments may be on different processing schedules. Please feel free to call us if you have questions about any of the bills related to your treatment. 

 

 

If you have questions regarding your physician bill, these are the people to contact:

 

For Radiology:  

McKesson @ 607-277-3790

 

 

For Anesthesia: 

Medical Business Management @ 607-277-3257

 

 

For Lab:

Pathology Associates of Ithaca @ 888-618-4581

 

 

For Urgent Care and Emergency Services:

Cayuga Emergency Physicians @ 800-700-9078

 

 

For Inpatient Medical and Intensive Care Services:

Cayuga Medical Associates @ 888-814-6459 ext 359

 

 

For Sleep Services:

United Medical Associates @ 607-770-0025

 

 

For Radiation Oncology:

Medical Management Services @ 800-689-1901 or 607-277-3257

 

Patient Service Call Center

We are here:

To help you understand your billing statement

To establish a payment plan for a billing statement

To process a payment on a billing statement

To update or change the insurance we have on file for you

To assist you in applying for financial assistance

To help appeal an adverse decision made by your insurance company

 

Patient Service Call Center hours: 8 am - 5:30 pm, Monday - Thursday
  8 am - 3:00 pm, Friday

 

Participating Insurance Plans

Please note:  having a contract in place does not ensure coverage. Since many insurance policies are unique, please contact your insurance company to verify coverage.

 

Medicare

As a medicare patient, you will have received a red, white and blue Medicare card from the Social Security Administration. This card shows your entitlement date and the claim number that is needed so the hospital can bill Medicare. Please bring your current red, white and blue card to admissions when you register so Medicare can be billed.

 

You may be entitled to Medicare benefits if you:

  have reached 65 years of age

  have had kidney dialysis for longer than two months

  have received a kidney transplant

  have been disabled more than 24 consecutive months and receive disability payments

 

Medicare does pay for :

            costs deemed medically necessary for your admission.   

 

Medicare does not pay for:

            your inpatient deductible

            charges for take-home drugs

            patient-requested private rooms

            the first three units of blood

            private duty nurses

            20 percent of the professional fees on some diagnostic tests

 

If you also have Medicaid or commercial insurance, those items not covered by Medicare will be billed to those insurers. If you have no coverage other than Medicare, those items will be billed to you personally.

 

The hospital is not allowed to bill Medicare as the primary insurance if:

  you or your spouse is still working and is covered by an employee group health plan

  you were involved in an automobile accident and therefore covered by another policy

  you were injured and another party may be liable for the injury

 

In these cases, Medicare will be billed for any balance that the primary insurer did not pay.

 

For information on other policies, you might find one or more of these websites useful:

 

CMS

 

Excellus Blue PPO summary
 

Medicare Advantage Plans in Tompkins County:


Advantra

 

American Progressive

 

Excellus

 

Healthnow

 

Humana

 

Wellcare

 

Medicare Supplemental Insurance

Cayuga Medical Center will bill your supplemental insurance carrier for any portion of the bill that Medicare does not pay. Remember, supplemental insurance will not necessarily cover charges not covered by Medicare. If full payment is not made, it is your responsibility either to follow up with the insurance company about their decision or simply pay the balance.

 

Blue Cross and other commercial insurance

Many private and commercial insurance companies provide health coverage. The terms of each contract or policy and the amount of coverage for specific hospital services vary greatly.

 

When you speak with the person in admissions, please give her or him:

          your policy or claims number

          the address to which a claim should be submitted

 

Some insurance companies require certain services to be pre-certified or pre-approved. You can get information about this from your insurance handbook or through your employer's insurance representative. Your insurance identification card may provide a phone number to call for verification and pre-certification of coverage.

 

If we have all of the necessary information, we will bill your commercial insurance company. We will bill you directly for any non-covered services or deductible coinsurance amounts not paid by your insurance company.

 

Cayuga Medical Center has contracts with these payers:

AETNA
AETNA/Chickering

CIGNA

Excellus Blue Cross

GHI

HealthNow

Loomis

Meritain        

MVP

PHCS / Multiplan

United Healthcare – Empire Plan (not commercial line of business)

 

Again, please note: having a contract in place does not ensure coverage. Since many insurance policies are unique, please contact your insurance company to verify coverage.

 

No Fault

For medical care as a result of an auto injury, please provide us with your auto insurance information in addition to your health insurance. It is your responsibility to file an accident claim with your auto insurance. You are responsible for any non-covered charges.

 

Worker's Compensation

If you are injured at work, we must bill Worker's Compensation for the treatment. The bill will be sent directly to your employer or your employer's Worker's Compensation carrier. It is your responsibility to make sure that your employer completes an accident claim and the appropriate Worker's Compensation papers to ensure prompt payment.

 

Medicaid/Medicaid Managed Care

Medicaid patients receive a monthly Medicaid identification card showing proof of eligibility from the Department of Social Services. Please present your current card to admissions personnel so Medicaid can be billed.

 

Medicaid eligibility is based on financial status as determined by the Department of Social Services. Medicaid may pay all charges, or you may have to pay a portion of your medical costs before you are deemed eligible for coverage. Your share of the cost, if any, as well as non-covered services, will be billed to you. If other insurance coverage is available, Medicaid will not pay until the other insurer has either paid or denied payment. Therefore, it is important that you keep us informed about your supplemental insurance policies. 

 

Family Health Plus and Child Health Plus

Some individuals who are not eligible for Medicaid do qualify for family programs sponsored by New York State, such as Family Health Plus and Child Health Plus. To enroll in Family Health Plus or Child Health Plus, you will need to meet with a “facilitated enroller.” (Facilitated enrollers are organizations that have been designated by the government to enroll people in government-sponsored programs.)

 

In Tompkins County, the facilitated enrollers for Medicaid Managed Care programs are Total Care and Fidelis. A representative from one of these organizations is on site two days a week in the Medical Office Building attached to Cayuga Medical Center. You can make an appointment to meet with the facilitated enroller by calling 800-223-7242 extension 2682 or 315-391-5371.

 

Some websites you may find helpful:

New York State:  Department of Health – Medicaid in NY State

New York State: Family Health Plus

New York State: Child Health Plus

 

In addition to traditional Medicaid, Cayuga Medical Center also participates with these Medicaid Managed Care Plans:

Fidelis Care

Total Care

 

Payment Options for Self-Pay Balances

If you do not have insurance coverage or if you have a balance after insurance has paid, the information provided here is important: 

Cayuga Medical Center understands that medical care can sometimes result in an unexpected financial burden. With this in mind, we offer the following payment options that are designed to help you resolve your balance:

 

Interest-free financing for patient balances

Financial assistance for qualified patients

 

 

Financial Assistance Program

Cayuga Medical Center will reduce or eliminate patient financial responsibility for necessary and appropriate treatment and prevention in situations where the individual requiring treatment qualifies under financial hardship guidelines. Determination of financial hardship is based upon the income and assets available directly to the patient (applicant), or indirectly available through a parent or legal guardian. Cayuga Medical Center uses the most current Federal Poverty Income Guidelines as a basis for these determinations. Each applicant for assistance must complete a written application and provide any information that is reasonably necessary to verify financial information. You can apply for financial assistance online. Click for online financial assistance guidelines and application


  • Click for Financial Aid brochure
  •  

    Please contact our Customer Service Representatives at 607-274-4400, Monday through Friday between the hours of 8:00 am – 5:30 pm, to arrange a payment option or apply for financial assistance.

     

     

    Frequently Asked Questions

     

    I believe my insurance provider should have paid my bill, but they haven’t. What should I do?

     

    Here are the next steps to take:

    1. Contact your insurance company to verify that they have received and processed the claim.

     

    2.  Review your insurance policy to determine if the service is covered. If you are unable to determine this, call your insurance company to see if the procedure is covered. Their personnel will have the most accurate and up-to-date information about your policy and your claim.

     

    3.  Call the Patient Service Call Center at 607-274-4400 to make sure we have the most up-to-date insurance information on file for you.

     

    Will my insurance cover my visit?
    Your insurance policy specifies whether or not services we offer will be covered. If you are not sure if a service is covered we suggest you contact your insurance company.  Their telephone number should be on your policy and your insurance identification card.

     

    My insurance has changed. What should I do?
    In order for your claims to be paid promptly, we need your most up-to-date insurance information so that we bill the correct insurance company. Please bring your current insurance card to all appointments so we can verify your most recent insurance information. If your insurance has changed, please advise the receptionist when you check in for services. You may also call 607-274-4400 to update your insurance information. Keeping us current will help prevent any delays in processing your insurance claims.

     

    I have insurance. Why did I get a bill?
    As a courtesy to you, we bill your insurance company directly for services rendered. The charges become your responsibility if your insurance company does not pay them. If you receive a bill, the most likely explanation is either that your insurance policy does not cover the services you received or we do not have your most up-to-date insurance information so we were not able to bill your insurance company.

     

    How did Cayuga Medical Center determine how much I owed?

    We as healthcare providers do not determine a patient’s co-payment or deductible amounts. Healthcare providers such as Cayuga Medical Center have contracts with insurance companies and the insurers pay us predetermined amounts for specific services provided. The amount the insurance company will pay is decided by the insurance plan and if that amount does not cover the balance of the bill, the remainder becomes the responsibility of the patient. 

     

    Can I pay all or part of my statement with my VISA, MasterCard or Discover card?
    Certainly. You may simply write your credit card information in the space provided on the back of your statement or call a Patient Service Coordinator at 607-274-4400 for assistance.

     

    Why did I get a bill for a balance I already paid?
    If a payment was received after the statement date, it will appear again on your next statement. 

     

    How do I change the mailing address on my statement?
    You may fill out the change of address section of the statement when you send in your payment. 

     

    Will my insurance pay for the charges listed on my statement?
    Your statement tells you which charges your insurance company did and did not pay.  The balance on the statement (“patient balance”) represents the amount left after the insurance company has paid its share. We request payment in full for the patient balance within 30 days of receipt of the statement. If you need to make payment arrangements, you can do so by calling the Patient Service Call Center at 607-274-4400.

     

    What forms of payment do you take?
    In addition to cash and personal checks, we accept Discover, MasterCard, and VISA. You can mail your payment to:

     

    Cashier

    Cayuga Medical Center

    101 Dates Drive

    Ithaca, NY, 14850 

     

    If I get a bill from a physician for services provided while I was in the hospital, can I send my payment to Cayuga Medical Center?

    The physicians are housed in independent practices which have their own billing and collection services. In order for your payment to be recorded and accurately and promptly, payment should be sent directly to the address listed on your bill, not to the hospital.

     

    My insurance company is telling me that Cayuga Medical Center is billing for an emergency room visit when I actually received care at the Urgent Care Center. Why?

    We use standard billing forms to bill for services provided. The Universal Billing form contains codes that have been established as the industry standard for billing. We have found this Universal Billing form to be the most efficient and effective vehicle for billing. However, the “one size fits all” approach does not fill every need with equal clarity. The bill can seem a bit confusing if you are not familiar with the codes, but there is a code included in your bill (456) that indicates you were treated in Urgent Care Services. The amount of your bill and the record of the procedures done in your treatment are correct and are not affected by any references to the emergency room. 

     

    My insurance company based their payment on Usual, Customary, and Reasonable (UCR) rates, and they did not cover all my costs. Are your rates unusually high?

    To the contrary, on average Cayuga Medical Center is one of the lowest-cost providers in the region. We’ve worked hard to keep our costs down because we are fiscally responsible and responsive to our customers. Our charges are “usual, customary, and reasonable” for this region. Our charges are very competitive to those of surrounding area hospitals.

     

    Whom do I contact to discuss a discount?

    In order to be fiscally responsible and to conserve resources for our financial assistance program, we do not have a discount program as such. However, we do maintain our financial assistance program to help those who have the willingness to pay but not the resources to do so. Our no-discount policy includes Cayuga Medical Center employees, board members, and physicians. The Medical Center’s charges are very competitive and payment plans are available.

     

    Definitions of Important Terms

     

    Advanced Beneficiary Notice (ABN)
    An Advanced Beneficiary Notice is a form advising you that tests performed by your doctor may not be covered by Medicare. The purpose of the Advanced Beneficiary Notice is to let you know in advance that these services may not be covered and to advise you that you will be responsible for payment of these charges.

     

    Approved Amount  

    Insurers assign a set cost to each medical procedure. Any amount above that cost is considered the responsibility of the patient. Therefore, the “approved amount” is the amount of the hospital's charge that an insurance payer will recognize in calculating benefits. (Under Medicare, this is also called the "Medicare Allowable Charge".)

     

    Birthday Rule
    This rule is called upon to decide which parent’s plan is to be considered the primary plan for dependent children. According to the Birthday Rule, the primary plan will be the plan of the parent whose date of birth (month and day) falls earlier in the calendar year. 

    For example, if the father's birth date is March 4 and the mother's birth date is January 22, the mother's plan would be primary. If both parents have the same birth date, the primary health plan will be the one that has been  in effect for the longer period of time. 

    The Birthday Rule is endorsed by the National Association of Insurance Commissioners (NAIC).

     

    Co-insurance 

    In some insurance policies, the insured person and the insurer share the cost of services.  The insurer pays a certain percentage and the insured person pays the rest. This system is one way of lowering the cost of the insurance policy. The co-insurance is the percent of the approved charge that the insured person pays.

     

    Co-payment

    In some insurance policies, the insured person pays a specified flat fee per visit or per unit of service (e.g., $50 for emergency services), with the insurer paying the balance.  The co-payment is the flat fee that the insured person pays.

     

    Deductible
    An insurance deductible is the minimum amount the patient must pay out of pocket before the insurance company will pay anything toward charges. Usually the deductible is not a one-time fee but is reactivated yearly.  

       

    Medicare Medical Savings Account

    Some people are eligible for a Medicare health plan option made up of two parts: one part is a Medicare MSA (Medical Savings Account) Health Policy with a high deductible. The other part is a special savings account, called a Medicare MSA (Medical Savings Account.) The funds in the Medical Savings Account are traditionally used for such things as deductible payments, preventive care not otherwise covered, etc.

     

    Original Medicare Plan

    This is the traditional pay-per-visit arrangement that divides coverage into “Part A” and “Part B” services. The amount of your coverage depends on whether you have coverage under Medicare Part A, Medicare Part B, or both. Typically, Medicare Part A pays for your inpatient hospital expenses and Medicare Part B pays for your outpatient health care expenses.

     

    Private Fee-for-Service Plan (PFFS plan)

    A PFFS plan is a Medicare Advantage health plan offered by a state-licensed provider who contracts with Medicare and Medicaid to provide Medicare benefits plus any extra benefits it chooses to provide. Some Medicare Advantage plans require patients to choose their healthcare providers from a prescribed network; in most cases, persons insured by a PFFS plan may use any health provider who accepts Medicare, rather than choosing from a specified network.   

     

    Referral

    A referral is a recommendation from your primary care doctor to see a certain specialist or receive certain services. Referrals are sometimes required before an insurance company will pay for treatment. Some specialists will only see patients who have obtained a referral. 

     

    Urgent Need Care

    Urgent Need Care addresses unexpected illness or injury that needs immediate medical attention but is not life threatening. Such care is billed under the heading of emergency services.

     

     

     

     

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