Understanding Insurance & Finances
When facing a cancer diagnosis, often times, the financial challenges the disease presents may seem as daunting as the medical condition itself. On the medical side of cancer care, patients talk to our doctors and nurses to learn about their diagnosis, resources available to them, and the multiple options available for treatment. Having this knowledge helps our patients and their families gain comfort and understanding to make the best decisions on their care. In that same way, our financial counseling team and insurance billing department work to ensure our patients have an understanding and comfort level of how their individual insurance works, potential financial resources that are available to them, and payment options that help alleviate these challenges.
Understanding Types of Healthcare Coverage
PPO Insurance Plans
Northwest Cancer Centers is in network for many PPOs (Preferred Provider Organization). Most PPO plans require patients to be responsible for a portion of their bill in the form of a deductible and out-of-pocket maximum. We will prepare and file claims to your insurance company. By following the tips listed below, our patients will have a good idea of the amount they may owe prior to the services being provided. To ensure timely processing of insurance claims, it is important that we have accurate information. Please notify our office if there are any changes to your insurance, employment, name, address, or phone number. While we will do everything possible to have all required authorizations in place, submit claims to payors, and educate the patient on their required deductible and copay amounts, this should not be viewed as relieving you of your obligation to pay the entire fee.
HMO & Managed Care Insurance Plans
Our practice contracts with multiple managed care plans. If you are covered by one of these insurance plans, be aware that these plans usually have specific procedures and steps that must be followed to receive treatment at a specialist. You must select a Primary Care Physician and may need a referral from that physician to receive coverage for specialty physician services. We encourage you to become familiar with your insurance benefits and rules. If you are covered by a HMO or managed care plan we contract with, we will guide you through the process of getting your treatment approved. But no services can be provided until the requirements of the plan are me. We recommend you contact your insurance carrier to verify that Northwest Cancer Centers and your physician are contracted with them as a participating provider. If not, they will direct you to an Oncologist or Hematologist who is in their network.
Medicare & Medicare Secondary Insurance
We accept Medicare assignment. We will file claims to both Medicare and your secondary insurance. If your secondary insurance is a Medicare Supplement Plan, the basic rule is that if Medicare covers 80% of a claim, the supplement will cover the rest. If Medicare denies the claim, then so will the supplement. The rules regarding Medicare coverage are consistent, so generally patients and providers will know prior to service if a claim is going to be approved. If your secondary plan is a private policy through a spouse, former employer, or union there may be additional benefits for services denied by Medicare. These policies must be evaluated on a case by case basis, similar to the HMO and managed care policies described above.
Medicaid
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. Currently Northwest Cancer Centers is approved as a provider for Indiana Medicaid. We do not accept Medicaid from any other states. While most patients enroll in traditional Medicaid plans, some choose a Medicaid Managed Care Plan. Medicaid Managed Care plans have regulations similar to those described in the Managed Care Insurance Plans section above. Please make sure to identify what type of Medicaid you have in order to avoid delays in treatment.
Understanding Additional Funding Sources
Financial Assistance Programs
In addition to your health insurance, many patients qualify for patient assistance programs funded by non-profit organizations, pharmaceutical manufacturers, or government agencies. Financial counseling is a free service available to every patient at Northwest Cancer Centers. Our financial counselor may assist patients to see if they qualify for any of these programs. These programs have helped our patients to receive hundreds of thousands of dollars in treatments. Our financial counselor will assist in completing the enrollment documents for programs that assist patients in paying for treatments provided at Northwest Cancer Centers. Our financial counselor can also provide patients information about programs that may assist them with day to day living expenses, transportation costs, wigs, etc... To inquire about these programs, contact our financial counselor at 219-924-8187 x234.
Clinical Trials
Another resource that may be available is a clinical trial. Clinical trials are sponsored by pharmaceutical manufacturers and government agencies. The primary purpose of a trial is to treat a patient while gaining knowledge about a new medication, protocol, or procedure. In many cases they offer patients a treatment option when there are no other clinical options. Another benefit to patients of participating in a clinical trial is that the study may also cover a portion, or all the medical charges associated with the treatment. Trials have very specific criteria for participation and are not available for all patients but may be a viable option for those who qualify.
Understanding Your Statement & Responsibilities
Tips for Getting Started
Here are a few tips that can help our patients gain knowledge and reduce issues in the financial process.
- When scheduling your first appointment, have your insurance information handy and provide it to your scheduler. This will allow our financial counselors to check your benefits and have an understanding of coverage prior to your first visit.
-At your first appointment, bring your driver's license or state ID and insurance cards with you. This will help us confirm the information we have is correct and reduce potential issues in the billing process.
- Don’t hesitate to ask questions: Our staff has decades of experience working with insurance companies, government agencies, non-profit organizations, and pharmaceutical manufacturers. All of these are potential sources to help meet the financial needs of treatment and other related expenses. You can call our financial counselor directly at 219-924-8178 ext 234.
-Understand how bills are generated: Depending on your insurance, location and the services provided, you may receive multiple statements for services provided in one location. For example, your insurance may require lab tests are processed at a different facility. This may result in a statement from us for our services and an additional statement from the outside facility who processed the samples we collected. If you have a question about your statement, you can call our billing department at the number on your statement. We can explain our portion of the bill. After speaking with us, if you have questions regarding another facilities bill, you can contact that facility directly with the understanding of how your bills were generated.
Statements
A billing statement is sent to you monthly. A statement will not be sent to the patient until the claim has become the patient’s responsibility. This means, all services will be billed, processed, and paid or denied by your insurance or other resources described above prior to being sent to the patient.
Patient Responsibilities
-Balances shown on the statement are due upon receipt.
-If you cannot make payment in full, please contact our office at (800) 331-9294 to make payment arrangements.
-If you have not provided verification of valid insurance coverage you will be expected to pay for the medical services you received on the same day they are provided.
-Northwest Cancer Centers collects co-payments at the time of service, as well as any other outstanding balances. Exceptions will be made only in the event of an emergency.
-You are responsible for the payment of any balance not paid by your insurance company, including co-insurance, deductibles and any amount in excess of your insurance company’s usual and customary limitations.
-Your insurance company will be allowed a reasonable period for payment of services. If payment is not received timely from your insurance company, you may be responsible for payment in full.
-You will be responsible for charges related to any returned check.