Health Insurance Frequently Asked Questions
Paying for your medical expenses can be confusing, and we'd like to help make the process smoother. Below you'll find answers to the billing and insurance coverage questions that patients ask us most. If you've recently received a bill or are planning an outpatient visit or hospital stay, please explore these Frequently Asked Questions.
Insurance FAQ’s | Payment FAQ’s | Medicare FAQ’s
Q. Should I bring my insurance card with me to the hospital?
A. Yes. The information on your insurance card is needed for the hospital to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and ask you sign a few forms. This registration process goes much faster when you bring your insurance information with you.
Q. Will you bill my insurance company for me?
A. Yes. As a courtesy we will bill your insurance company, or companies. It is your responsibility to provide any requested information to your insurance company (accident information, claim forms).
Q. Will the hospital file Worker's Compensation, motor vehicle accident or medical liability claims for me?
A. Yes. We will bill Worker's Compensation insurance if the patient provides the information. We do not bill third party insurance plans (i.e. attorneys, auto insurance) except if the patient has Medicare. We allow the patient to bill liability insurance him or herself but require the patient to pay the hospital bills because we can not become involved in liability disputes.
Q. Do I need to let my insurance company know that I'm going to be in the hospital?
A. We strongly advise you to check with your insurance company or your employer about this. Because there are so many types of insurance plans, it is difficult for us to tell you whether or not you need prior approval or notification for your hospital stay.
Q. How do I know if my insurance company will cover my visit or certain services?
A. Coverage varies with each insurance company. Generally, the hospital staff does not know whether a particular service will be covered. Medically necessary and appropriate services may not always be covered by your insurance contract. Please refer to your insurance member handbook or contact your insurance company or your employer with specific questions about what is or is not covered by your insurance plan.
Q. How do I know if my insurance company will cover services provided by all professionals (i.e. anesthesiologists, radiologists, and pathologists) involved with my treatment?
A. We encourage you to check with your insurance company or your employer about this. Each professional needs to contract individually with insurance companies and the hospital does not know if each professional is contracted with your insurance company.
Q. How do I follow-up with my insurance company?
A. Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Obtain satisfactory status of account. If paid, ask when and to whom. Note this information and whom you talked to at the insurance company. If the bill has not been paid, find out when the anticipated payment date is, and ask if they need anything from you. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor.
Q. How will I know if my insurance company has paid my bill?
A. If there is a balance due from you after the insurance company has paid its portion, we will send you a statement. This statement indicates the amount that has been paid and any balance you are required to pay. This is your bill. You are required to pay this bill in full or will need to contact our office.
Q. What do I do if I disagree with how much my insurance company has paid on my bill?
A. If you disagree with the insurance company's payment amount, contact the insurance company and ask them to review how the claim was processed. If the insurance company finds that an error was made, note the information and name of the person you talked with at the insurance company. Request an anticipated payment date and ask if they need anything from you. If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an appeal with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration.
Q. How can I pay my patient balance?
A. We offer the following payment options:
- You may pay by mail using a credit card, check or money order. We accept Mastercard, Visa and Discover cards. Make check or money order payable to the hosptial where the service was received, and include your account number. Mail to:
Wheaton Franciscan Healthcare - Payment Processing Center
PO Box 5434 Dept 0027
Carol Stream, IL 601970-5434
- You may pay by telephone using credit card or check. We accept Mastercard, Visa, and Discover Card. Please contact the Business Office at (877) 304-6332 to make a payment.
- If you are paying a bill from one of our hospitals, you may pay your bill online using credit card at www.mywheaton.org/billpayment. We accept MasterCard, Visa, and Discover Cards. Please note that online bill payment is not available for Wheaton Franciscan Medical Group at this time.
- If paying by cash, please go to the Cashier Window at All Saints, Elmbrook Memorial, Franklin, St. Francis, St. Joseph, or the Wisconsin Heart Hospital.
Q. Do I have to pay my co-payment at the time of service?
A. Yes, you are expected to pay your estimated co-payment after services are provided.
Q. When will I receive a bill?
A. If you verified your insurance information when you registered, you will not receive a bill until:
- Your insurance company has paid the claim, leaving a coinsurance, deductible or non-covered services.
- Your insurance company has denied the claim.
- Your insurance company has not responded to the claim.
Q. What if I get more than one bill?
A. You may receive more than one bill for the same hospital stay. These bills are for services provided by physicians, anesthesiologists, radiologists or other professionals. If you have questions about a specific bill, please call the phone number listed on that bill.
Q. When do I become responsible for my bill?
A. You are legally responsible for your bill at the time you receive services from the hospital. We require all patient balances be paid immediately after you are notified.
Q. Who can I talk to with questions about my bill?
A. Wheaton Franciscan Customer Service Representatives are available to help you over the phone with any questions or concerns you may have about your bill. Representatives are available Monday through Friday 8:00am until 8:00pm. Call (877) 304-6332.
Q. How can I get a copy of my hospital bill?
A. Call the Customer Service Department at (877) 304-6332 and request that a copy of your itemized bill be sent to you. Be sure to communicate the Account Number from your statement if you are leaving a message.
Q. Why doesn't Medicare cover all medications given in the hospital setting?
A. Medicare does not cover medications that they identify as self-administrable.
Medicare states that any medication that a person receives in the hospital on an outpatient basis that they could take themselves under normal circumstances is considered self-administrable. This would be things like pills, tablets, etc. The patient is billed for self-administrable drug charges.
Q. Why do I have to give you information about other insurance if I have Medicare coverage?
A. In some cases such as a car accident worksite injury or injury on someone else’s property, Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill Medicare. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. It is the hospital's responsibility to make sure those claims are filed appropriately.
In addition, if you have primary insurance coverage and Medicare is your secondary insurance plan, we need to bill the primary insurance first.
Consequently in all cases, we need to have complete information about all insurance coverage you have.
Q. Do I have to sign any forms before Wheaton Franciscan can bill Medicare?
A. You will be asked to sign a Consent for Treatment form each time you receive services. You will also be asked questions each time you receive services that Medicare requires we ask.
Q. What is a Medicare Explanation of Benefits form?
A. The Explanation of Benefits form is an information document that Medicare sends to you after it has processed your medical claims. The Explanation of Benefits form provides you with information about the payment status of your bill.
Q. What is the difference between Part A and Part B Explanation of Benefits forms?
A. Part A covers inpatient hospitalization and Part B covers outpatient and physician services.
Q. What should I do with the Explanation of Benefits form?
A. We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the Explanation of Benefits from you before they will pay any remaining balance on your account.
Q. Should I pay the balance that is listed as "your total responsibility" on the Explanation of Benefits form?
A. No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from your medical provider before making payment.
Q. Will I have to pay any money for my hospital visits?
A. As a Medicare patient, you will only be responsible for non-covered charges, co-pays and deductible amounts. These amounts may vary depending on your Medicare coverage. We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know your responsibility, we will bill your other health insurance company (if you have coverage) for the balance. (This seems to contradict earlier statement that says Medicare requires you to bill other insurance first before they will pay anything – which is accurate?) If you do not have other health insurance, you will be billed for the balance.
For more information:
Hospital visit questions at (877) 304-6332.