Out-of-Network Surprise Billing Disclosure
You are responsible for the cost-sharing amounts required by your health plan, including co-payments, deductibles, and/or coinsurance. If you are seen by a provider or use services in a facility or agency that are not in your health plan’s network, you may have to pay additional costs associated with that care. These providers or services at facilities or agencies are sometimes referred to as “out-of-network.” Out-of-network facilities or agencies often bill you the difference between what your insurer decides is the eligible charge and what the out-of-network provider bills as the total charge. This is called “surprise” or “balance” billing.
Estes Park Health does not enroll with Medicaid related Insurance Plans from states outside of Colorado. Accordingly, any patient with an Out of State Medicaid plan may be billed for their service, however it is unlikely that the out of state plan will cover the cost. We will send the bill to the patient’s plan, but ultimately, the patient is responsible for the cost of the service. Financial Counselors are available to provide financial assistance in accordance with Colorado regulations.
For details about our financial assistance program:
- Financial Assistance Program Description (English)
- Financial Assistance Program Description (Español)
For more information:
There is Help to Better Understand Your Medical Billing Questions
Estes Park Health knows that trying to understand your medical bills can be difficult at times. The Estes Park Health Patient Financial Services team has taken the steps to become a Certified Application Assistance Site to help you apply for appropriate financial assistance and better assist you with your billing questions. Estes Park Health provides quality health care services to all patients without discrimination, regardless of their ability to pay.
Estes Park Health Patient Financial Services team can answer your questions
Many changes have taken place in the health insurance industry in recent years. Procedures and services once covered in full can now be partially covered, covered only under certain circumstances or in some cases not covered at all. Your insurance plan can deny payment for services or procedures even after they have been completed. Many health maintenance organizations (HMOs) and insurance plans now require pre-admission notification, approval or second opinions for certain procedures.
To help you navigate these on-going changes, Estes Park Health now provides you with access to a Patient Financial Customer Service representative (970-577-4530), two Financial Counselors (970-577-4327 and 970-577-4528) dedicated to resolving patient balances and two Pre-Access Services Specialists (970-577-4524 and 970-577-4525)who will meet with patients for pre-op appointments to help you understand your financial responsibility to the hospital and/or your health care provider based on your insurance benefits. They will assist you in understanding terms like:
- Co-payments – The portion of your bill you are required to pay for during registration. Co-payment amounts vary depending on your insurance policy.
- Deductibles – The amount your insurance company determines you must pay before they begin dispensing benefits on services rendered.
- Co-Insurance - Coverage in an insurance plan where the insured pays a share of the payment made on an account. For example, a patient with 70% co-insurance would mean their insurance plan pays 70% and the patient is responsible for 30%
- Insurance Claims – The bill for services the hospital submits to your insurance company or companies.
- Itemized bills – A list of individual charges for services and procedures you received during your hospital stay. Also lists your account number.
- Patient Balance – The amount on your bill that you need to pay.
- Statement of Account – Shows any activity (for example, insurance payments or denials) that has occurred since the itemized bill was sent.
Since every insurance plan is different, please be sure to check your coverage and ask questions prior to receiving treatment. Not following your insurance company's rules could result in a larger financial responsibility for you. Estes Park Health Financial Counselors can help you understand your financial rights and responsibilities associated with your services and procedures.
Questions you might have about your bill
You are not the only person to have questions about your hospital and/or physician bill. We have compiled a list of often asked questions that might help you understand the billing and payment process.
Does the hospital need a copy of my insurance card?
Yes. Your insurance card contains information we need to file a claim with your insurance on your behalf. Your registration process goes much faster when you bring your insurance information with you.
When do I have to pay my co-payment, deductible and co-insurance?
You are expected to pay your plan-required co-payment, estimated deductible and/or co-insurance at the time of service. Estes Park Heath accepts cash, personal checks, money orders VISA, MasterCard, Discover Card, American Express and Health Saving Account (HSA) cards.
Will the hospital bill my insurance company for me?
Yes, the hospital will, as a courtesy to you, send your insurance company a bill for services you incurred as a patient. It is important to remember, however; that the hospital relies on you for settling your account in full regardless of your insurance coverage. Your insurance policy is an agreement between you and your health insurance carrier. Often your insurance company will request information from you before making a payment on a claim.
Are my physician's charges incorporated in my hospital bill?
No, your physician's bill is separate from the hospital bill. You may get multiple bills for medical services performed by professional medical personnel such as physicians, radiologists, pathologists and anesthesiologists. Please contact their private offices with questions about their bills.
When should I expect to see my bill?
*This timeline is approximate and does not reflect special circumstances.
|Patient Visit||0 Days||Co-Pay or Co-Insurance and/or Deductible down-payment Due|
|Charging||0-4 Days||Our charges are added to the account.|
|Coding||0-4 Days||Diagnosis and procedure codes are added to the account.|
|Insurance Billing||5-10 Days||Claim is sent to the primary insurance.|
|Insurance Payment||30-60 Days||Insurance payments are expected 45 days of the date billed. Payment time can vary significantly.|
|Secondary Insurance Billing or Patient Billing||31-61 Days||Once your primary insurance has correctly paid, if there is a balance we will bill your second insurance. If you do not have other insurance, we will send you a bill for any remaining balance.|
|Requested Full Payment of Bill||60 Days|
What if I am having difficulties paying my co-payment, deductible or co-insurance?
Our Patient Financial Counselors are available and here to assist you. You can call 970-577-4327 or 970-577-4528 to schedule an appointment.
What if I do not have insurance? Am I eligible for other health benefits?
Patient Financial Counselors can discuss available options, work with you to determine the payment arrangements that will work best for your situation and help you apply for financial assistance. You can visit eph.org/patients-visitors/billing-payments to review a copy of the Estes Park Health Financial Assistance Program.
Who do I call if I have questions about my bill?
Our Lead Customer Service Representative can help you understand the billing process and is available to assist you as needed. You can call 970-577-4530 with questions.