Financial Arrangements

Insurance

If you provided us with insurance information, your insurance company will be billed as a service to you. Insurance is designed to reimburse the policyholder and is a contract between the policy holder and the insurance company. We will submit benefit claims to your insurance company if all required information and authorization is provided. You are responsible for deductibles, co-insurance and any items not paid by insurance. You should contact your insurance company to determine your cost-sharing responsibilities, if any.

Billing

A claim will be submitted to your insurance based on the information you provided during registration. This could be as soon as three days after your discharge or release from the hospital. Please be aware that each time you receive services from us, a separate account is created. It is possible to have several accounts open at the same time. You may request a copy of your bill by contacting the customer service representative in the Business Office. Generally, we allow 30 days for insurance to pay their portion. In the event that your insurance company is slow to pay or for some reason disallows the claim, payment of the full account balance is expected from you. You can avoid future billing notices by calling your insurance company to expedite payment. Our collection process will include additional billing notices every 28 days until the account balance is paid or placed with a collection agency.

It is important for the hospital and the patient to work together to solve payment issues. If you have any questions, please feel free to call our hospital Business Office Customer Service Department.

Payment

Payment in full is required at the time of service from all patients who owe co-pays or co-insurance, have not met their deductible, or do not have insurance coverage. Balances after the insurance payment are due upon receipt. You may contact the hospital Business Office if you are unable to pay your balance in full. The customer service representative in our Business Office is available to answer any questions regarding your bill, as well as set up payment options if you're not able to pay your bill in full by the third billing statement. All patient accounts that have not been set up on a payment plan within 10 days of the fourth patient statement being sent will be placed with a collection agency.

Estimates for upcoming scheduled or future elective services can be provided upon request by the hospital scheduling departments.

We have several payment options available to our patients. Payments are accepted in person at the Cashier's Office at the front of the hospital across from the Gift Shop Monday through Friday from 8 a.m.to 4 p.m. For payments that need to be dropped off after business hours, a drop box is located on the door at the Cashier's Office. To save time and postage, you can pay your bill on our website. To make a payment by phone, you may call our Cashier at 337.462.7146. Payments can be made via:

• Cash, check or money order.
• Visa.
• Discover.
• MasterCard.

If you have any questions or disputes and would like to speak with our customer service representative for clarification of your bill, please call 337.462.7146.

Financial Assistance Programs

Our hospital is committed to meeting the healthcare needs of the communities we serve. Emergency medical care is provided to everyone, regardless of ability to pay or lack of insurance coverage. Financial assistance is available to help eligible patients who cannot afford to pay for their healthcare services. Please note that eligibility criteria, terms and conditions vary for each of the financial assistance programs listed below.

Our financial counselor can help you further understand if you qualify for any of these programs and assist you with the application process for the Medicaid and Indigent/Charity Care programs. Once you have the required documents for each program listed below, please call 337.462.8502 for an appointment. Walk-ins may be accepted only if no other appointments are scheduled during that time.

The following documents are required to apply for the Medicaid programs listed above:

• Birth certificate and green card (if you were not born in the USA).
• Social Security card.
• Driver's license or an identification card.
• Your last month's bank statements for checking and savings accounts.
• Proof of income for the last 30 days (pay stubs, Social Security award letter, etc.).
• Unpaid medical bills for the last 90 days (ER doctors, hospitalist, radiology, etc. are billed separately from the hospital).
• Life, health or burial insurance policies.
• Asset documents (documents for a second home or a second car).
• If applying for a disability, you will be required to provide the names and addresses of physicians/hospitals where you have been seen within the last two years.
• List of medications, the dosage and how often the medication is taken, if applying for disability Medicaid.

Third-Party Billing

During the care you received at our facility, you may have received services from physicians or other medical providers, such as anesthesiologists, CRNAs, radiologists, Emergency Room physicians, etc. You will receive separate bills from these physicians or medical providers. Should you have any questions concerning their bill, please contact them directly. To help you determine whether the independent healthcare professionals who provide services at this facility are participating with your health plan, this healthcare facility has provided you with a complete list of the names and contact information of each individual or group.