Insurance Frequently Asked Questions
Most insurance plans now require that inpatient hospitalization be pre-certified or pre-authorized within 24 hours of admission in order to be eligible for full policy benefits. It is the patient’s or the guarantor’s responsibility to see that this is completed. This information can be found on your insurance card. If you are unsure of pre-certification requirements, we urge you to contact your insurance company as soon as possible. Admitting will verify your benefits with your insurance carrier.
Q: Will Dallas Regional Medical Center send my hospital bill to my insurance company?
A: Dallas Regional Medical Center will file claims on all accounts in which there is complete insurance information (insurance name, address, policy number, group number, etc.). Bills are generally submitted to the primary insurance company within seven days from your visit. If you have a secondary insurance company, a claim will be submitted to the secondary insurance company after the primary insurance company has paid.
Q: How long will it take my insurance company to pay their portion of the bill?
A: On average, an insurance company will process a claim within 45 days. At times you may need to contact the insurance company to assist and expedite this process.
Q: Why did my insurance pay only a part of my bill?
A: Most insurance plans require that you pay a co-payment, coinsurance, and/or a deductible for your health care expenses. Your bill may include charges that you are responsible to pay, such as non-covered items or out-of pocket expenses. Contact your insurance company for specific information pertaining to your coverage.
Q: Why do I need to call the insurance company if they do not pay the bill?
A: If you have a PPO policy or an individual policy, you are ultimately responsible for the total biIl or any portion of the bill your insurance plan does not pay. Dallas Regional Medical Center will make every effort to collect payment on the account from your insurance company, but we may need your assistance to resolve any concerns.
Q: How can I find out if my insurance has paid or how much they have paid?
A: When your insurance company processes your claim you should receive an explanation of benefits (EOB) in the mail. The EOB will contain payment information and the amount due from the patient. Contact your insurance company with questions about the status of a claim or how the claim was processed.
Q: If I have an HMO policy, can I be billed if they do not pay?
A: If you have an HMO policy, you should only be billed for the amount specified on your explanation of benefits (EOB) that is provided to you by your insurance carrier. This usually includes co-pay amounts.