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
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
accepts your insurance and the service(s) you seek are covered by your policy.
accepts your insurance, but some or all of the service(s) you seek are not
covered by your policy.
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
bills will include:
hospital tests and services
charges may include:
or holding bed
services (including lab specimens sent to us by physicians' offices)
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
If you have questions regarding
your physician bill, these are the people to contact:
McKesson @ 607-277-3790
Medical Business Management @
Pathology Associates of Ithaca @
For Urgent Care and Emergency
Cayuga Emergency Physicians @
For Inpatient Medical and
Intensive Care Services:
Cayuga Medical Associates @ 888-814-6459 ext 359
For Sleep Services:
United Medical Associates @
For Radiation Oncology:
Medical Management Services @
800-689-1901 or 607-277-3257
Patient Service Call Center
To help you understand your
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
Service Call Center hours:
||8 am - 5:30
pm, Monday - Thursday|
||8 am - 3:00
Participating Insurance Plans
note: having a contract in place does not
ensure coverage. Since many insurance policies are unique, please contact your
insurance company to verify coverage.
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.
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
● have been disabled
more than 24 consecutive months and receive disability payments
does pay for :
● costs deemed medically necessary for your admission.
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
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.
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
cases, Medicare will be billed for any balance that the primary insurer did not
information on other policies, you might find one or more of these websites
Excellus Blue PPO summary
Medicare Advantage Plans in Tompkins County:
Medicare Supplemental Insurance
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
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.
speak with the person in admissions, please give her or him:
or claims number
to which a claim should be submitted
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.
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
Medical Center has contracts with these payers:
PHCS / Multiplan
Healthcare – Empire Plan (not commercial line of business)
please note: having a contract in place does not ensure coverage. Since many
insurance policies are unique, please contact your insurance company to verify
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.
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
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.
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
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
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.
websites you may find helpful:
New York State:
Department of Health – Medicaid in NY State
State: Family Health Plus
New York State:
Child Health Plus
addition to traditional Medicaid, Cayuga Medical Center also participates with
these Medicaid Managed Care Plans:
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:
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:
financing for patient balances
assistance for qualified patients
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
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?
the next steps to take:
1. Contact your insurance company to verify
that they have received and processed the claim.
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.
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
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?
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
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.
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:
Cayuga Medical Center
101 Dates Drive
Ithaca, NY, 14850
get a bill from a physician for services provided while I was in the hospital,
can I send my payment to Cayuga Medical Center?
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?
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.
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?
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.
I contact to discuss a discount?
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
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
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.
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
Birthday Rule is endorsed by the National Association of Insurance
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.
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.
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
Medicare Medical Savings Account
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
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)
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 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
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