Insurance Claim Procedures

Patients are responsible for the cost of services received at Methodist Hospitals. To assist you in meeting your financial obligations, Methodist will bill your insurance company. However, if your insurance company has not paid within 60 days, (as required by the State Insurance Board), the unpaid balance may become your responsibility.

HMO/PPO

You are responsible for providing information regarding your plan coverage at the time of admission or registration. Please understand and comply with the requirements of your insurance. Know your benefits, and obtain proper authorization for services when required. The HMO/ PPO plans may require a referral, prior authorization, or certification prior to services being rendered. If you receive a service that is not covered by your insurance, you may be asked to sign a statement indicating that you have been informed of your payment responsibility. If your insurance requires a co-payment or deductible, you may be asked to pay that prior to the service being rendered.

  • Obtain a referral or certification prior to scheduling appointment.
  • Obtain authorization for treatment from Insurance Company if required.
  • Submit doctor’s order with diagnosis.
  • Bring ID Card (insurance card) and Drivers License to Admitting/Registration.
  • Pay deductible or co-payment prior to appointment.

Managed Medicaid

Medicaid Managed Care plans such as Managed Health Services, MD Wise, or Anthem Medicard may require a referral or prior authorization from your primary care physician prior to services being rendered. Please provide the doctors order along with the authorization number from your physician. Failure to obtain a referral or certification prior to services being rendered may cause the services to be ineligible for coverage and become 100% the patient’s financial responsibility. If you receive a service that is not covered by your insurance, you may be asked to sign a statement (non coverage letter) indicating that you have been informed of your payment responsibility.

  • See your primary care physician first for course of treatment
  • Obtain a referral prior to scheduling appointment.
  • Submit doctor’s order with diagnosis.
  • Bring ID Card (insurance card) and Drivers License to Admitting/Registration.

Traditional Medicaid

If you receive a service that is not covered by Medicaid, you may be asked to sign a statement (non coverage letter) indicating that you have been informed of your payment responsibility. If you have a spend-down, payment arrangements need to be made.

  • Submit doctor’s order with diagnosis.
  • Bring ID Card (insurance card) and Drivers License to Admitting/Registration.

Medicare

Methodist Hospitals bills Medicare and supplemental insurance for inpatient and outpatient charges. Patients are responsible for any charges not covered by Medicare.

  • Submit doctor’s order with diagnosis.
  • Bring ID Card (insurance card) and Drivers License to Admitting/Registration.
  • Inform registrar is you have supplemental coverage(s).
  • If you have no supplemental plan, you may be asked to pay the inpatient deductible prior to admission.

Workers Compensation

Methodist bills all authorized carriers for Workers Compensation claims. To be eligible for Workers Compensation coverage, the patient must have the employer accept liability for the claim prior to admission. Patients must provide the claim number, claim representative’s phone number, workers compensation insurance carrier and the employer’s name, address, and telephone number.

  • Obtain claim number
  • Provide billing address
  • Provide employers name, address, and telephone number.
  • Authorization may be required for subsequent treatment.

Accident Coverage

Methodist will bill the appropriate auto and/or health insurance plan for your care as a result of an auto accident. However, due to substantial payment delays involved in pending litigation of personal injury cases, you will be responsible for the charges.

  • Provide Auto Insurance Carrier name, address, and phone number.
  • Provide claim number
  • If claim is in litigation, determine how outstanding balance will be paid.
  • Provide Attorney name, address, and phone number if applicable.

Healthy Indiana Plan

Hoosier Healthwise

State Health Insurance Assistance Programs

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