Knowing what your plan covers, what your out-of-pocket responsibilities are, and how to navigate benefits ensures you can access the right services when you need them. Understanding medical bills and insurance coverage can sometimes feel overwhelming. Our Financial Services team is here to help answer your questions and guide you through the process with care. Click here to learn more about our Financial Services team and how they can support you, or read our most commonly asked questions below.
Our billing team is here to help. Meet our team of Patient Advocates and Patient Navigators by clicking here.
Q: I just got a bill, why didn’t my insurance cover this?
A: We completely understand how frustrating it is to open a bill you weren’t expecting. Usually, these charges apply toward a deductible, co-insurance, or a co-pay. Every plan is unique, much like how car insurance might cover a windshield but not a fender bender. We’d be happy to look at the specifics with you. You can also reach out to your insurance carrier directly to learn exactly what your benefits cover.
Q: My insurance company said my claim was coded wrong. Can you fix this?
A: It can be confusing when you get conflicting information. We make sure to code every service exactly as the provider documented it in your medical record. We’re more than happy to double-check the coding for you to ensure accuracy upon your request, though it is quite rare for those professional medical codes to change once they are filed.
Q: I don’t understand what all my charges are for?
A: Medical bills can definitely be overwhelming to read. We can certainly simplify this for you! We’d be happy to send you an itemized bill that breaks everything down. If you’d like to go over it line by line, you can visit us at the Glencoe Clinic Monday through Friday (8 a.m. – 4:30 p.m.), or we can walk through it together over the phone.
Q: I was in for a physical; why am I being charged for it?
A: Physicals are such an important part of staying healthy and are usually covered as preventive care. However, if a chronic condition (such as diabetes or anxiety) is managed or discussed during that same visit, insurance requires a separate charge for that additional care. In the future, you’re welcome to schedule your physical separately from your chronic care follow-ups to keep those visits separate.
Q: I’m picking a new plan, which ones do you accept?
A: That’s a big decision, and we want to make sure you’re covered! We accept most major plans. You can give a potential carrier our NPI number (1508885633) to confirm we are in network. One helpful tip: since some specialized care requires a transfer to larger networks like Allina or the Mayo, it’s a good idea to ensure your new plan covers those systems, too.
Q: What are “self-administered” drugs and why am I paying for them?
A: Patients are often confused as to why they see a separate charge for medications given during a visit. For patients with Medicare, certain medications like those you would normally take yourself at home aren’t covered under Part B during an ER or observation stay. The good news is you can often submit these to your Part D (pharmacy) carrier for reimbursement. Our financial services team is here to help you with those forms if you need us!
Q: Why was I charged twice for one office visit?
A: It may seem like a double charge, but it’s actually how we’re required to bill as a Critical Access Hospital. We have to split the bill into two parts: one for the doctor’s time and one for the use of the facility and equipment. It’s a federal requirement from Medicare, but it all represents that single visit you had with us.
Q: My card says my co-pay is $25, why am I being billed $40?
A: Co-pay amounts can change depending on the “tier” of the clinic or the type of provider you saw (like a specialist versus a primary care provider). Your insurance company should be able to provide a benefit document that will have the most accurate breakdown of those different co-pay levels.
Q: I haven’t been to GRH in a long time; why am I just now getting a bill?
A: We apologize for the delay. We want to make sure your insurance pays every penny possible before we ever send a bill to you. Sometimes, this involves a long-appeal process where we send medical records to prove the care was necessary. We’ve started mailing “appeal notices” so you aren’t caught off guard, but we realize it’s still a long time to wait for your final bill.
Q: I went to Urgent Care, but it’s billed as Emergency.
A: This can come as a surprise for many individuals. When you arrive, our nursing team triages you to the safest level of care based on your symptoms. Sometimes, even if you’re hoping for Urgent Care, the treatment or medications you need can only be safely provided in the Emergency Department. Our team tries to communicate this at the start, but it can be a difficult transition to navigate.
Q: Why did I get a bill? I just paid this a few days ago!
A: Thank you for being so prompt with your payment! Our systems usually have a 2-3 day “handshake” period where the payment is processed and applied to your account before it reflects on our website or stops a statement. If you paid in the last few days, you can safely disregard that notice!
Q: My procedure was pre-approved, so why did I get a bill?
A: A “prior authorization” is just the insurance company saying the procedure meets medically-necessary criteria. It isn’t a guarantee that they will pay the full cost. They still apply your standard deductibles and co-pays. We always recommend checking your specific benefits so you know exactly what your “patient responsibility” portion will be
Q: What is a “Critical Access Hospital?”
A: As a Critical Access Hospital, we’re a specially designated hospital designed to keep high-quality care right here in our rural community, because when you need care, every minute counts. Because we are smaller and rural, the federal government has us bill differently than big city hospitals. It’s a bit complex, but it’s what allows us to keep our doors open for the community.
Q: What is the difference between diagnostic and screening tests?
A: Think of it like car maintenance! A screening is like a routine oil change: you don’t have a problem, you’re just preventing one. A diagnostic test is like taking the car in because the “check engine” light is on. If you have symptoms and the doctor is looking for a cause, insurance considers that diagnostic, which often changes how it’s covered.
Q: Can I appeal my own claim?
A: Yes, absolutely! You are your own best advocate, and sometimes insurance companies listen best to the person who holds the policy. You can call the number on the back of your card or visit their website for the forms. We’re right here to support you with any information you might need to make your case!